Why it is that modern science is so occupied with large statistical studies, and is not at all invested in the qualitative aspects of working with one person and or phenomena at a time? All of the hoopla with evidence-based practice, which I feel is extremely important for the future of the field of music therapy and health, seems, to me, to be de-emphasizing “clinical-based practice”- which I’ll informally define as a practice being informed by the process clinical of experience. How many studies how you read in which the research is more about numbers then people, and in turn, it loses sight of the core deficits of a particular diagnosis that it is claiming to treat?
To that end, I’ve just returned from giving a presentation at a prominent autism organization in NYC in which I discussed the effectiveness of integrating the DIR Model and interactive music therapy with children with ASD. I used video excerpts from sessions to illustrate the concepts and to demonstrate the social-emotional gains that each child experienced through their therapy process. The President of this particular organization, who was in tears, asks, “where’s the evidence to support this approach?” He continues to say that, “although your work is valuable and amazing, individual cases can not contribute to science. We need the evidence.” I replied with a wonderful quote by the world famous neuroscientist, V.S. Ramachandran, “I believe that individual cases have everything to contribute to science. I asked him, “Imagine I were to present a pig to a skeptical scientist, insisting it could speak English, and then waved my hand, and the pig spoke English. Would it really make sense for the skeptic to argue, ‘But that is just one pig. Show me another, and I might believe you!’ “
Great post!
Quite a vignette–I’m trying to imagine a person moved to tears by the humanity of clinical process, and saying it’s “valuable,” yet still dismissing it on a fundamental level, based upon what he witnessed not being predictably replicable. Science isn’t only about what is replicable, but also what is possible. I wonder what he said after the excellent story of the talking pig you provided (I, for one, may have used the example of the 1986 Mets!).
I also think of the arts here–Mozart’s 40th Symphony is a miraculously beautiful work–does there need to be another one, in order to justify its value? No, that’s not how the humanities work. Quite the opposite from predictable replication, their value and virtue are found in uniqueness and originality. Yet an artist has definite skill to help bring about such unique, original expressions–particularly when on a grand scale of aesthetic architecture (as in the case of a Mozart 40th Symphony).
It is interesting that, when demonstrating the artistry of work such as music therapy, it’s not considered “enough” without the predictably replicable dimension. Not only would this contradict the principles of the arts (upon which a field like music therapy is founded), but would contradict the principle of the client’s agency (one cannot simultaneously be considered to be an agent of one’s own life, yet also be a “thing” that can be predicted statistically).
My own reaction to the critic in your vignette would be to draw his attention to his tears, as inter-subjective confirmation of the evidence of true health art (versus health science). I would pointed out that the video excerpts, in the context of the health arts, are the equivalent of hearing an original composition, in the context of the performing arts. It is already evidence of its own value.
BA
We see this often in medicine where a scientist tries to reduce it to numbers not unlike physics. But it doesn’t quite work that way. A person isn’t just a bunch of numbers. Run a blood test and get a few numbers maybe but that doesn’t mean that the person has cancer. You have increased the likelihood but until you get in there and look you can’t be sure.
Studies in therapy can give you guidelines, routes to travel, but a therapy patient isn’t patient Type J. He is patient Mikey. You need to try things on him, see what routes work and what routes don’t. You may need to come out with brand new treatments that you never needed to try before. You need to treat your patient like a person because he isn’t just a bunch of numbers and you aren’t a physicist studying the clouds of Jupiter. You are a person interacting with another person. The only way you can know what works is to find something that works and then use that as a guideline for other kids.
In the time my son (who has Down syndrome and autism) has been receiving music therapy he has had ABA treatments, changes in medication, and other therapies besides music therapy. No single treatment has improved Mikey. It is the combination of all his treatments that has made him at 13 a much improved young man. Music therapy has been a key part of all his therapy and it is the interaction and examination of how the therapy works with him and how it needs to be changed and improved with him that has made music therapy work for him.
I loved your poignant way of putting things. I too struggle with ‘justifying’ to others the power of music therapy and the validity it has in changing lives. I too have shown videos of my work, moved people to tears and gotten the same response. And still, they respond with there’s no evidence. I say to them that the evidence is in the moment and that they have witnessed it. Then I say, show me the proof that the speech and occupational therapy you continue to approve is working…often the school officials insist on the continuance of minimally-effective strategies (as evidenced by a lack of clinical progress across a year or more) when clearly music therapy offers more. Sad to say, sometimes it gets political. I cannot wait for the day when music therapy gets the credit it deserves. Til then, we’ll all keep pushing along, yelling it all the way.