Abstract
‘Essentials of Music Therapy Assessment’ by Gattino is a helpful addition to the music therapy literature. The author begins by outlining his definition of assessment in relation to music therapy practice, and how this has been established drawing on assessment practice in more developed fields such as psychology and education. Gattino states that ‘music therapy assessment involves aspects of judgment and empathic responses related to the act of judging or deciding about another individual, by means of musical interventions during a music therapy process’ (p.14). He then thoughtfully guides the reader through the process of assessment, from preparation and data gathering to analysis and communicating results to clients, families and other professionals. While the focus is on assessment of individual or group clinical sessions, and the different ways assessment can be used throughout the therapeutic process, Gattino also briefly touches on how the music therapist can use assessment techniques to evaluate music therapy services on an organisational level. The book is framed in the context of music therapy practice at the time of writing during the COVID-19 pandemic, which impacted all aspects of people’s lives around the globe. He challenges the music therapy profession as a whole, and as individual practitioners, to carefully evaluate and critique our assessment practices and (re-)consider assessment as a central and vital part of the therapeutic process. While at times the book can feel somewhat prescriptive in achieving this aim, it will serve as a source of information and guidance to advance music therapy assessment practice.
Assessment is part of the music therapy process regardless of theoretical approach, geographical location or the setting of the clinical work. Music Therapists often begin clinical work with an assessment of the individual or group, outline how they feel music therapy could be of service (aims of treatment), and then provide timely evaluations of the therapeutic process. Finally, the Therapist will likely provide a closing report evaluating the therapy against the initial aims and outlining any further recommendations. Gattino rightly challenges why, then, the theory and practice of assessment has not been further developed and explored within the music therapy field, necessitating the author to turn to the fields of psychology and education to find more developed literature on the topic. This is especially demonstrated towards the end of the book (Chapter 19) where Gattino investigates the teaching of assessment in our bachelor and master music therapy training courses around the world. Of 152 courses identified, Gattino found only 29 of these outlined a specific course or teaching module related to assessment. While this does not imply that the remaining 123 courses do not teach assessment, it raises a question about the attention given to the practice of assessment in our field and suggests there could be development in both assessment training and practice.
To meet this gap, the author provides a thoughtful and in-depth discussion of the theoretical background of music therapy assessment from different perspectives. The structure of the book is clear, gently guiding the reader through a suggested assessment process from beginning to end. Each chapter is bookended with a question and summary answer, helping the reader to follow the author’s thought process, providing the feeling of progressing through a taught course. While helpful when reading cover-to-cover, this will also aid readers to dip in and out of the book and find relevant content to specific queries. There appears to be an editorial error in the final chapter, where the conclusive statement seems to have been inserted in the middle of a discussion of assessments in virtual settings. However, notwithstanding this, the book is clearly structured, making the text user-friendly.
The author dedicates a chapter early on (Chapter 4) to the discussion of how the role of assessment will vary depending on the context of the therapy. For example, in a school setting it will likely be possible to see a student regularly over a set number of weeks, whereas this is less likely to be the case in hospital settings where clients might only be seen once. This is helpful in shaping the readers thinking on what assessment tools might be suitable for their own clinical work, and to prepare well for changes of clinical setting. Gattino also creates a distinction between an assessment of the therapeutic process and an assessment, or evaluation, of a music therapy service as a whole which ‘consists of reviewing the service, ensuring its quality, and supporting financing decisions’ (p. 76). While the book then continues to mainly focus on the assessment of clinical practice, much of the content may be relevant in contributing to an evaluation of a music therapy service, which is vital to demonstrate the value of music therapy to stakeholders and enable growth.
While the author discusses different settings in which music therapy assessment might take place, many of the descriptions of assessment practice, and the accompanying example documents, are more relevant to certain music therapy approaches than others. For example, the use of different assessment tools and analysis of music are rightly discussed, alongside the different ways to implement these. However, the importance of the Music Therapists’ clinical judgement and the use of psychodynamic constructs, such as transference and countertransference, in the inter-personal relationship are not mentioned. Yet, these concepts for many Music Therapists, at least those practicing in the United Kingdom, are crucial to gaining an insight into the therapeutic process, highlighting the challenges of writing for a global audience. This could point to a difference in training, or perhaps therapeutic stance, between the author and the reviewer, but nevertheless this omission stood out to me as a Music Therapist in the United Kingdom. This also renders discussions around reliability and bias more complicated, as not all practitioners will aim to achieve reliability, focusing on the experiential, inter-personal relationship. Perhaps it would have been helpful for Gattino to be more transparent about his own music therapy training, practice, experience and clinical framework to help the reader frame the descriptions and examples given.
The author is clear in his assertion of the importance of Music Therapists having a clear understanding of the perspectives that underly their own clinical work, and different theories of lifespan development. Gattino states that, whatever perspective or theory of lifespan development used by the reader, assessment plays a key role. However, at times it seemed that the practice of assessment as described by the author became quite demanding and specialist, for example conducting highly skilled data analysis or transcribing musical improvisations, and it seemed unlikely that many Therapists would have the time to conduct some aspects of assessment as described within day-to-day clinical practice. It might have been helpful if the author acknowledged this and highlighted the cross-overs with different fields of research where those with specific expertise might be able to provide support.
Throughout the book, the Music Therapist is placed in a position of the expert, with little mention of how we can co-work with other healthcare professionals, and indeed, with our clients and their families, throughout the whole process of assessment. While the importance of sharing assessment results in an accessible way is included, no discussion is given to how goals or aims might be set alongside and in discussion with the client, their families, and other professionals, or indeed the therapy ‘plan’ derived collaboratively to reach those goals. Increasingly, there is a move towards co-production and working alongside our clients in therapy, placing them and their loved ones as the expert. This approach might not be fully applicable to all assessment tools or approaches – for example, if conducting a pre and post standardised assessment test to measure change, it might be helpful to not discuss this in detail with the client beforehand to limit bias. However, it is a shame that the role of the client in contributing to the assessment of their therapy, and the importance of sharing their voice with other professionals, was not discussed.
The book introduces a lot of complex processes that are central to assessment, including ethical and cultural considerations and the collection and analysis of a variety of types of qualitative and quantitative data. Gattino endeavours to define all terms used, making the book accessible to all regardless of their experience with the topics discussed. However, the descriptions were often lengthy, which could sometimes distract from the core message. In a topic this broad, it is understandable that a huge range of areas need to be addressed. Yet, at times, the narrative could lose focus in an attempt to comprehensively cover a topic rather than pointing to additional texts where the reader could find more information. One way that the author helpfully captures and displays large amounts of information was through the frequent use of tables. While sometimes the reason for the categorisation was not clear, these demonstrate the depth of the author’s knowledge and will provide a valuable resource for many Music Therapists.
However, due to the complexity of some of the subjects addressed in the book, there were times where aspects were over-generalised and some important areas were not mentioned or described in enough detail. For example, in the discussion on how to interpret quantitative and qualitative data, the author seems to suggest that quantitative data is more reliable and objective than qualitative data, with interviews referred to as an ‘informal’ method of data collection which lacks ‘methodological rigour’ (p. 20). While this may be true in some circumstances, it is still possible to analyse and present statistics in a way that is more or less favourable to the Therapist’s intentions, and there are many examples of interviews used, particularly in the social sciences, as a formal way to gather in-depth data on a subject. In the same way, a statement provided from the client, if given in an environment where they feel supported and able to speak openly, might provide a valuable assessment of the therapeutic process. In addition, ways to improve the validity and reliability of an assessment, for example, through improving the design of the data collection and analysis, are not discussed. At these points, the author might have stated the limitations of the book to fully address all relevant content and indicate to the reader where they might find more detail on the topic elsewhere.
At times, the level of description becomes somewhat prescriptive, for example, in Chapter 17 Gattino describes in detail how music therapy records should be stored, both for physical and online copies. While this might be helpful for newly qualified or trainee Music Therapists, it is important to ensure that the reader is aware that these are examples, and there may be other methods that the Therapist develops or that are required by their place of work that are equally as effective. In addition, many of the concepts discussed, such as record keeping, are not unique to assessment practice but relate to all aspects of music therapy practice. Acknowledgement of this could help reassure the reader, especially if relatively new to the profession, that much of the content discussed will draw on elements covered in training and likely be part of the professional standards of conduct for music therapy in their country.
Overall, ‘Essentials of Music Therapy Assessment’ is a thought-provoking and useful addition to the music therapy literature, opening up and driving discussions around the role of assessment in music therapy. Although some of the content appears to relate more closely to specific approaches to music therapy, such as a behavioural approach, the content will be useful for all Music Therapists regardless of experience, clinical approach, or setting. Gattino challenges the music therapy community where assessment practices are not as developed as other related fields such as psychology and education. Yet, it is clear that we can learn from these practices to continue to build the rigour of our own assessment methods. However, it is important that this is done without losing the integrity of the Therapist and client(s) interpersonal experience, played out through co-creating music, as the defining and unique element of our work.
