When I first qualified, my first place of work was in a college working with young adults with additional needs making their transition into adulthood. This has been a really varied and interesting place to work, and so different from any other client settings I have worked in. I am very excited to be running a workshop with some of my colleagues at Chiltern Music Therapy on this work at the BAMT conference next weekend, where we will be running through some of the different approaches used (you can book your place at this workshop on the booking form sent to delegates tomorrow).
One of the activities we are workshopping is on using music listening in sessions as a way of developing therapeutic relationships, exploring identity, linking with and processing experiences and emotions, and as mood management/arousal regulation. This is something that my colleagues and I have used fairly extensively in our sessions, and yet something we all wondered if we ‘should’ do as Music Therapists. It is so outside what we had learned during our psychodynamic training where clinical improvisation was the main focus, and it felt quite conflicting to be doing this. Yet, we feel it has added enormous therapeutic value to our work there.
I have since reflected on this a lot whilst preparing for our workshop, and have thought about how it has also been useful in my previous work in an adult hospice. Here, the patients were going through a transition of their own: from the lives which they were so used to, into the changes that their illness inevitably would take place on their bodies and on their every day activities and relationships. I couldn’t help but think about how listening to specific recordings was intensely important for people going through a significant transition in their life, and that there was no way that I could reproduce this experience by playing these songs myself. In a broader context, I also noticed how the country seems to be going through a period of reminiscence and nostalgia with 90s culture (at least, my generation are), and how this also seems to be at a time of huge transition and uncertainty of the future.
One thing that we all agreed on was that listening to music in sessions felt a lot more tangible and secure for our clients, compared to clinical improvisation. In fact, clinical improvisation has featured far less heavily in our work at the colleges, and normally when it has been there it has been designed to be a lot more structured or focussed than what we would have trained to do. Perhaps there is something about the fragility about making a transition, and needing something more solid to act as the vehicle for change.
But why did it feel so unsettling as newly qualified Music Therapists to do this in sessions? I guess part of it is wanting to do a good job and feeling the need to really prove ourselves as competent Therapists, and sometimes the need to prove to people who aren’t in the know that music therapy itself is a credible health care provision. Anybody could listen to music, right? What makes it therapeutic? And does it need to be a Music Therapist who has undergone intense and regulated training to carry this out, or could it be any other Therapist, keyworker, carer?
I guess the answer is, no, not necessarily. But I do strongly feel that Music Therapists are in the best place to do this, and that they can offer this with a high level of skill and expertise. It may be that other people can also provide this in some form, and that is great, but it will always be very different to what we can do in our sessions.
So once I had come to the conclusion that listening to music can be highly therapeutic and was definitely acceptable to do in my work, I had to learn what my role was in this. What can I do that makes this activity different to just listening to music at home with your mates? And what can I physically be doing when the iPad is already playing all the music for us?
First of all, for many of my clients, my role was to facilitate the music selection process. Depending on their abilities, this could be supporting them in communicating or even thinking of music they actually like, something not to be taken for granted! And for some people, just having access to a wide library of music (or, any music) is something that they may not have, and this was often the most powerful thing of all (Chiltern Music Therapy are currently running an iPod pharmacy for this very reason).
Next, I would say that my role was to use the music as a way of starting conversation, to shape discussion, and to facilitate containment and processing of experiences and emotions. Verbal counselling skills is something that we didn’t spend a lot of time learning about in our training, and this was something that just had to come with a lot of practice and reflection and continues to be something that will constantly change and develop with each new client (However, I do want to clarify that the training did give me enough skill to be able to work this out for myself on the job, they didn’t leave me totally incompetent!). With this comes the importance of using the shared music listening experience to develop a positive therapeutic relationship, and I would say all the usual psychodynamic processes such as transference/countertransference can take place here.
Most importantly, as with all my work, my role was to use my expertise and insight as a Music Therapist to monitor the client’s mental health state and to support them in developing healthy coping mechanisms. This would be based on my knowledge of mental health and the impact of music on the brain from my Therapist training, knowledge of music and culture from my music training, and the unique nuances of the particular therapeutic relationship with that client.
This requires some level of acceptance and awareness of the power imbalances between Therapist and client within the therapeutic relationship. This is often heightened even more within music therapy, as we also carry an extra level of skill as a professional musician. Within music listening, a lot of this power seems to be removed somewhat and I have found it very useful to learn how to be OK with that, in fact I think it is a positive thing that this activity can feel more mutual. It is OK that I am not using the highest form of my skill set here like I may do in clinical improvisation, and it is definitely OK to be flexible enough to use a huge variety of music based activities within sessions.
It can also be very rewarding to learn new music from our clients that we never heard before, an educational and informative experience for us! I think we shouldn’t disregard the importance of what our clients also give us within our work. I will never forget how a former patient insisted I borrow one of his CDs, and now it is one of my favourite albums and I always think of him whenever I hear it. This was a really positive thing for both of us and just as valuable as the more traditional and highly regarded approaches in our work.
So is this music therapy? Yes, it is. So are lots of other music based activities. And some of these activities may have a lot of crossover with work that other people do, such as community musicians, counsellors, SALT, OT, but this is also OK. The difference is that as Music Therapists, we should feel confident enough to know what is needed for our clients, and to either provide that for them ourselves in our own highly specialist way, or to know when it is more ethical to hand this over to the appropriate person when it doesn’t need to be us or to discharge the client when they can do this for themselves. I am proud to work in a profession where we can offer so many varied and wonderful things for so many different people, and I think it is important to not get anxious about doing something slightly unorthodox if it is what our clients need.