Abstract
This volume of 11 chapters by music therapists and dramatherapists from across the United Kingdom, Europe, Australia and the United States working in a range of settings and services joins a raft of recent publications about collaborative work including Strange et al. (2017) and Colbert and Bent (2018). An accessible read, it swiftly lays out a set of clinical descriptions and examples that may well appear quite familiar to therapists of both modalities, where elements of both music and drama are clearly present within the work. This is followed by accounts of more explicitly intended and organised collaborations, where the range of interventions that are shared is extended. The biggest surprise, as noted by more than one contributor, is that so little has been explicitly discussed or written about this before.
In an enjoyable opening chapter, dramatherapist Sue Jennings describes her experiences in the formative years of the professions, before training courses or the boundaries between disciplines were fully formed. Working with others including a music therapist in training, psychologists, nurses and social workers, she describes a sense of freedom, experimentation and generosity in a melting pot of practice. Collaborations took place across settings and age groups, included all modalities, and frequently culminated in performances. Jennings also briefly references her social anthropology studies in Malaysia and her experiences of integrated ‘seances’ of music, dance and drama. This gives us a glimpse perhaps into an original form of arts therapies that is echoed in the developing practice in the West.
At the end of the book, in chapter 11, founders and tutors from the MA Dramatherapy and MA Music Therapy courses at Anglia Ruskin University (Oldfield, Richards, Carr and Doktor) describe the development of the MA Dramatherapy course and the decision to actively integrate aspects of the teaching and learning for the two courses. This goes beyond the more predictable/generic areas of, for example, psychological and clinical theory to include the development of a shared module on clinical improvisation using structures from music and drama. Here there is a similar sense of experimentation to the work described in chapter 1, but this time with the informed and developed histories and structures of the separate professions that have been worked out over time providing a context and container for this innovative work. Compared with the pioneer days, the authors describe a rather more reserved and hesitant quality about using each other’s forms in the trainees, a reliance on the other as expert and a need to be taught to be freer in the use of self, instruments, voices, objects and forms. Perhaps this is the result of a few decades of discipline-specific development which separated the art forms from each other.
In between these two accounts of early and late integration of practice, we read some clear description and careful analysis of what has perhaps been so natural as to be largely unremarked thus far: the interface and interaction of elements of music and drama within the separate practice of therapists of both modalities.
Stories emerge spontaneously in music therapy (chapter 2) and music emerges naturally in dramatherapy (chapter 3), and in both cases each enhances the primary modality and enables a fuller use of the sessions. There are interesting accounts of the use of puppets in psychotherapy (chapter 4), kazoos in music therapy (chapter 6) and the use of songs by a dramatherapist in work with elderly patients (chapter 5). Much of this latter chapter will be very familiar to music therapists working in dementia care who are likely to use songs as a means of stimulating memories and offering opportunities for coherent self-expression. It was interesting to read how the addition of dramatic work around the songs gave opportunities for exploring and extending narratives and, significantly, creating new ones. A lasting and helpful idea from this chapter for me was the concept of different forms of intelligence including body/kinaesthetic and music/rhythmic forms as well as the more usual linguistic/logical.
It is not until chapter 7 that we hear from a dramatherapist and music therapist working together in the same room at the same time. Ellinor and Georgaki describe their efforts, working in different modalities at different PMLD schools, to provide a ‘joined up’ service to pupils transferring between the two. Group work to support this significant life transition is holistically linked into the wider school setting at both sites and is presented as a form of adapted practice, or therapeutic activity. A joint session, co-run by both therapists, provides the handover and the format of the group is brought over to the new setting. Needless to say, while this sounds simple, it is supported by lots of work behind the scenes to think about the needs of the individuals and the group. Another piece of work by this pair of therapists involved them seeing two siblings, one at each of the schools, together. There is an interesting account of this work, the differing personalities of the siblings and the consequent difficulty of bringing the therapies together with movement eventually providing the connecting glue.
The only other piece of joint clinical work included in the book (but written up by the music therapist alone) comes from Poland. In chapter 9, Konieczna-Nowak describes an innovative 6-week project-based group work intervention for young people with emotional, behavioural and social inclusion needs. This is facilitated by a dramatherapist with a music therapist co-worker, and forms part of a music therapy training course in Poland where trainees join the groups as participant-learners. Dramatherapy structures are used to create a story that is largely improvised and built on over the course of the project. Music is used to support, enhance and develop the storylines. Narrative outcomes from this work indicate that the two modalities provide different but complimentary functions, with drama allowing for balancing between narrative and descriptive factors and music providing a catalyst and emotional container. Although not formally evaluated, feedback from both trainees and clients indicate the experiences of building bonds, learning to manage one’s responses and understand others’ perspectives are reported as helpful. For the students, there is additional learning around issues of exposure and authenticity and the importance of understanding themselves in the context of developing their therapeutic practice.
In chapter 8 from the United States, Reynolds and Davis describe the development of musical theatre work by dramatherapists who were working clinically with clients experiencing trauma. Using song, stories and a live musician, the therapists created a performance piece that was delivered at a dramatherapy conference which explored their experience of their clinical work, and their own trauma. The participants drew on a model described as ‘developmental transformations drama therapy’ in which the roles of therapist and client are fluid, and real qualities and feelings of the therapist will be present as well as imaginary or dramatic ones. The experience of trauma is linked to split off parts of the self and the development of the performance piece explores what happens to the unorthodox, unperformed, unsung parts of the self. In a similar way to the students in the Polish group, and the trainees in the Anglia Ruskin joint improvisation module, the group members experience anxiety about exposure and vulnerability, about what might be revealed about the therapists complex feelings about their clients or their personal references to family or friends. The authors’ reflections on the qualities of the modalities include the ability of scripts and characters to provide a therapeutic container and give dramatic distance from raw material. Music may also provide a means of concealing the self within a (pre composed) song but, when curated so, songs can elicit a feeling that corresponds with the emotional landscape of a character and thus allows emotional and physical expression of deeper feelings more so than text alone.
Some themes that emerge from the book include for me a certain sense of looking anew at something that was always there. As a music therapist, I certainly have many lived examples of dramatic structures appearing in music therapy work: a client who intoned versions of his life story to me over our shared drumming, and another who walked the room ‘cleansing’ the space with shakers and making intonations. A girl who allotted characters and roles to instruments and a boy who told stories that we made into a sound track with special effects. More than that, I will go one step further and add in the appearance and use of movement in therapy sessions, as frequently happens in the book, perhaps as an aspect of dramatherapy practice, but also as an expression in its own right. In an inpatient music therapy group I currently co-run, we notice that people bring many creative aspects of themselves. There is music but there are also dances, stories, songs, incantations, histories, recitatives, enactments, questions, fantasies, sculpts and sometimes dramas: not all at the same time hopefully, or at least not too often. It was helpful and encouraging to read accounts from therapists who have begun to take more detailed notice of this and started to describe and analyse what happens in these everyday experiences of work.
Once we start formalising joint modality work, as we have been doing as a team at East London NHS Foundation Trust over the last few years, we may find that we need clearer parameters and descriptions for what we are doing. The detail of how to bring modalities together, when to do so and why, can be complex and we may wish to start organising and codifying what we are doing a bit more rigorously. This is a good thing, a means of informing practice, but also has the potential to de-skill us of things we might previously have taken for granted.
In a reflection of this careful dance, one intriguing strand running through the book is about the different qualities attributed to the modalities at different times. More than once, dramatherapists refer to music – in particular songs – as allowing a more embodied, physical experience beyond use of texts or stories. Elsewhere, music therapists are seen as needing help to connect more authentically to physicality, which dramatherapists are seen to do with ease. Key to managing this balance of who holds the expertise, where, when and why, and a powerful theme in the chapters on joint practice, is the importance of the working relationships between the therapists and their ability to work with honesty and integrity, to put aside ego, build up trust and be prepared to take risks. I particularly welcome this sense of generosity shown by the contributors, their desire to share, and to learn from each other, and in many cases, from the service users. This, along with an often understated use of aims and objectives that are transparent, agreed with the clients and reviewed to track progress and process, places the work within a welcome recovery framework, although this is not at the cost or exclusion of what other models can contribute to therapeutic practice.
There are a few typos and errors in the text which is a shame, but they do not interfere with the content or message of the articles. Overall, this book is an interesting and useful addition to the literature on collaborative work in general, and specifically to advancing the discussion of the potential of music and drama as they appear as elements with single modality therapeutic practice, and what they might exponentially offer in collaborative therapeutic work.