Abstract
Introduction
Susanna Bajali, Helen Short, Emma Bailey, and Claire Flower work within the music therapy team in the Cheyne Child Development Service at Chelsea and Westminster Hospital in London. Working as part of a multidisciplinary team, the music therapy service provides short-term work to children under six with developmental disorders and their families. This book review was a joint project; each of us bringing our varying experiences and perspectives as we read different sections and discussed our thoughts and responses.
Aalborg, Denmark, is the seat of a vibrant music therapy tradition of practice, research, and training. The three editors of the book are renowned Music Therapists based there and have in common their roles within the training course at the University of Aalborg. The foreword by Helen Odell-Miller helpfully sets the scene of the text, locating it firmly within the Danish context from which it comes.
The second edition integrates new research and literature from the intervening 15 years since the first edition. The layout of the book has been revamped with the chapters broken down into more subsections which are now included in the index. This means the reader is more easily able to find an area of interest or pick out a specific section. The book is certainly comprehensive and covers a vast array of information while still managing to feel concise and succinct in quality. A valuable asset to this publication is the presence of the late Tony Wigram’s voice which remains present from the first edition.
Chapter 1: introduction to music therapy
The opening introductory chapter leads the reader straight into detailed accounts of the history of music therapy, going back to antiquity. It is fascinating to read about the different ways music has been used in health and healing down the ages. As this history is not covered much in UK training, a lot of this may well be new information for the reader and offer the chance to view the profession from a different perspective. This then leads well into a discussion on current definitions and models of music therapy, providing a succinct overview of some of the possibilities and conflicts afforded by the many ontological and philosophical perspectives on music, meaning, and health.
What the Introductory section does not do is signal to its readers what the book as a whole is seeking to do, or map out possible ways of navigating through it. Perhaps in some ways this is liberating – we are not told how to read it, or what we might expect to gain from doing so, but rather allowed to journey through it freely.
Chapter 2: theoretical foundation of music therapy (Susanna Bajali)
Chapter 2 covers the ‘Theoretical Foundation of Music Therapy’ and packs a lot in to just over 100 pages, with contributions from seven different authors. I found, when reading, that it was refreshing to experience the change in style and voice offered by the different authors. Naturally, I found some authors easier to read and engage with; the best chapters for me were those in which the authors made clear connections between theory and practice through vignettes, and in the case of the chapter on Metaphorical Listening, by inviting the reader to listen to the audio tracks which accompany the book. Some authors discussed theories in great detail but more or less left the reader to work out the application for music therapy practice themselves. For example, the opening chapter Music in Body and Brain is highly technical and includes many diagrams of the brain, but has very few examples of how this detailed information can be used practically by the Music Therapist – for example, Neurological Music Therapy is not mentioned at all.
The next major section, Therapy Theories, begins by outlining five main schools of therapy. However, it goes on to elaborate on just two of them: cognitive-behavioural and psychotherapeutic. I wondered why the other approaches (narrative/constructivist, biologically oriented neuropsychiatry, and community-oriented social psychiatry) were not explored more, especially given the growth in recent years of community music therapy (aligning with community-oriented social psychiatry) and Guided Imagery in Music (aligning with narrative/constructivist therapy). Perhaps the philosophical basis of these schools also deserved the space to be explored. As the subsequent sub-chapters go on to explore psychodynamic theory, transpersonal theory, and music as metaphor, it seemed that section (2.2) could easily have been subsumed into the later sections and been replaced by a more succinct general introduction.
When reading the chapters on Analytical and Psychodynamic Theories I sometimes found myself wondering how accessible they would be for someone unfamiliar with psychodynamic concepts, for instance a student or someone interested in the profession. At times, it seemed there was a large amount of assumed knowledge and concepts/terms were not always explained.
What is evident when reading is the great depth of knowledge and experience of the authors. They draw together many theories, charting their development through time and highlighting research from around the world including newly developing and emerging areas. A reader interested in any of the areas covered will find many fascinating avenues of research to pursue. Generally speaking, the ‘schools of therapy’ and their theories were presented without critique; controversies and debates are alluded to but without detail. More critique would have added a valuable layer to the writing.
Chapter 3: selected music therapy models and interventions (Helen Short)
Situating ourselves to those who are unfamiliar with our profession, such as commissioners or other healthcare professionals, is still a very prevalent task within our profession and the authors have clearly made this a priority. In Chapter 3, the whole picture of using music in health is painted, ranging from the therapeutic use of recorded music in the operating theatre (Music in Medicine) to the psychoanalytically informed model Analytically Oriented Music Therapy. This is regularly summarised in the form of helpful charts or diagrams, such as the descriptive model of health musicking in section 3.13.
The selected models are presented in a style that is accessible and straightforward for the trained clinician to digest and the uniform structure makes them easy to compare and contrast. Having said that, I feel that the clarity and detail in the description of the models vary, for example, the detailed description of the Guided Imagery in Music (GIM) procedure and techniques (P.163) really brings the text to life and allows the reader to imagine what it would be like to be a GIM practitioner. However within the section on Nordoff-Robbins Music Therapy (3.4), the lack of similar detail means the writing does not feel as vibrant.
At the start of the chapter the authors clearly articulate their reason for choosing their selected models, all had been previously selected as established models at The 9th World Congress of Music Therapy in 1999. The authors use Bruscia’s definition of a model of music therapy, cited on page 157: a ‘. . . systematic and unique approach to method, procedure and technique based on certain principles’ (Bruscia 2104, p. 128). Since Neurologic Music Therapy is undoubtedly an internationally ‘well known’ model that fits this description, it is surprising that it is only referenced briefly within the Behavioural Music Therapy section.
One of the most enjoyable aspects of reading this chapter was encountering the interesting ideas that jump out to the reader, such as the research of Standley referenced in the Cognitive Behavioural Methods section, in which music was used to stimulate sucking in premature infants. Although I would say that this chapter might predominantly serve as a springboard to further learning for the experienced UK practitioner, as a reader I can say I attained a rich learning experience exploring concepts that are unfamiliar to me such as Benezon’s model of music therapy and vibroacoustic and vibrotactile therapy used for physical treatment.
In terms of the publication’s relevance, proof of the pudding is certainly in the eating. During the process of reviewing this chapter I consulted it several times; the section on music listening groups was helpful when I was required to adapt my clinical approach as a result of pandemic-related restrictions put in place in my workplace and I used the section on the Physiological Effects of Music Therapy to help provide my clients with coping strategies outside of the session.
Chapter 4: music therapy in clinical practice (Emma Bailey)
Chapter 4 comprises seven sub-chapters, each covering an area of music therapy practice. Chapter 4.1 notes that the material is structured primarily around Danish music therapy practice, but this is justified as it is thought to reflect wider international trends. From a UK perspective this is broadly applicable, but readers may find that certain approaches occupy more space than would fairly reflect their more local music therapy practice. For example, final sub-chapter 4.7 (Music therapy and personal growth) might have been better incorporated in a reduced form into 4.6 (Music therapy and psychosocial problems). Nevertheless, Chapter 4 as a whole consolidates substantial and diverse content in a commendably succinct 150 pages.
By and large, each section stands alone, lending it well to students and qualified music therapists looking to explore new areas of practice. Some sections follow a repeated structure, which at times feels a little formulaic, but is a helpful navigation aid, where it is used.
In places the text is thick with references, but somehow this does not interrupt the flow. Ulla Holck’s 4.3.1 (Music therapy with children with developmental disability) is a standout example of this, and is, incidentally, wonderfully detailed yet concise, and jargon-free. 4.5 (Music therapy for people with somatic diseases) is also diligently signposted. The inclusion in 4.2 (Music therapy in psychiatry) of the patient voice and associated audio extracts bring the text to life in a startling way.
Although some authors included several international references, the vast majority of references throughout Chapter 4 are to Danish music therapy practice. Although this certainly presents an impressive showcase of music therapy breadth in this part of the world, there was at times a sense that casting the net more widely may have enhanced the accessibility and potential for application by non-Danish readers. For example, 4.6.2 (Music Therapy in Family Therapy) lacked even a passing reference to UK literature on music therapy with families, and Neurological Music Therapy appears only once, in 4.4.2 (Music Therapy for Persons with Acquired Neurological Conditions).
As a reader, one of the most striking characteristics of the chapter is its shared authorship, between eleven clinicians. Although this offers an impressive depth of knowledge and experience, and enables each sub-chapter to be read independently, there is at times a sense of a lack of oversight of the chapter as a whole. For example, there is no clear introduction, referencing the rich and diverse content to come, setting the scene and reflecting on changes from the first edition perhaps. The opening section 4.1 (Referral Criteria and Clinical Practice in Music Therapy – An Introduction) appears unchanged from the first edition, and as such does not contain any developments since 2002. The brief summary closing 4.7 could likewise have been expanded to draw together of reflections on the state of practice as a whole, and offer thoughts for future pathways of practice.
Chapters 5 and 6: music therapy research and evidence-based practice and music therapy training – a European BA and MA model (Claire Flower)
As a reader involved in both research and training, these chapters held much of interest for me. Chapter 5 begins by posing question as to what is, and isn’t research. While outlining key principles simply, the questions become more complex as the authors clearly articulate contemporary challenges in research. These include the selection of research approaches and methods to offer the best fit in a discipline often characterised as a ‘context-dependent treatment’, and how to resist the lure of the conventional quantitative/qualitative binary. For readers unfamiliar to the ideas and language presented here, the discussion of case research serves to ground the chapter in what may feel like more familiar terrain. This helps to make research accessible for the practicing therapist, although that accessibility may be compromised by some minor points. Descriptive research, for instance, is described as usually having ‘more than 10,000 participants’, (p. 401) a figure that seems unfeasibly high, and is contradicted by examples citing studies with both 65 and 183 participants, respectively (p. 404). A minor, if confusing point, in an otherwise helpfully clear chapter.
Chapter 5.2 is concerned with Assessment and Clinical Evaluation, beginning by making the case for assessment in music therapy practice, and the necessity for the development, of standardised assessment tools. At the outset, I was unsure whether the chapter’s focus was on assessment itself, or on research into assessment. In truth, it probably sits across the two, given the research experience Lindahl Jacobsen brings to this area. Following an overview of selected assessment methods, a detailed clinical example is examined. It is here that the echo of Prof Tony Wigram’s practice, research, and writing is most clearly heard. The multi-disciplinary case material of the example demonstrates the vital and enlivening contribution music therapy makes within such an approach. It is, of course, exactly the improvisatory nature of music making that often confounds attempts to standardise assessment. This is a tantalising question that, in what seems a missed opportunity, the authors only engage with lightly.
The Aalborg PhD is the subject of Chapter 5.3, and can be paired here with Chapter 6, entitled MT Training: European BA and MA. Both are concerned with trainings, and, as a window into the Danish tradition, are well worth a read. Between them is a brief but important chapter on Evidence Based Practice in Music Therapy. The imperative to provide evidence that music therapy ‘works’ is a familiar one, and this chapter lays out concepts such as hierarchies of evidence, and Cochrane reviews to make its case. It doesn’t, however, engage more fully with current questions such as what constitutes evidence, or how practitioners manage the tensions created when large-scale trials fail to provide the hoped-for evidence. I would have liked the authors to have tackled some of these issues more directly.
Conclusion
This publication is useful in demonstrating how wide we have cast our net as a profession and the scope of possibility we have as Music Therapists to expand our practice. The broad selection of material is contributed from a diverse range of voices and although this means at times the content feels disjointed, there is a wealth and depth of information that provides a thorough insight into European Music Therapy culture. For those Music Therapists looking to incorporate models of working situated outside their original training, this book is a wonderful resource. Certainly, the publication has much to commend itself to a range of readers including Music Therapists, trainees and interested outsiders alike, offering inspirational and practical content on a wide range of music therapy practice.