Hi all,
In jotting down some ideas based on music domain areas, I came a across a couple of questions that I would love to have some feedback on. The ideas are grounded and based on the idea that musical are clinical goals. Can they be? Let’s say it’s within the context of relationship in music therapy. Can musical goals be clinical in the context of relating and developing deep relationships (looking solely at the musical)?
The following is based on the idea that when writing a music therapy goal plan, musical domain areas are not stressed enough, yes? No?
If music therapy is our area of expertise, and, the identity that we have chosen when deciding a profession, why do we, music therapists, focus on other domains areas outside of the musical when crafting a treatment plan? I do see, however, the importance of understanding and adapting to biological (including emotional) challenges that may interfere with a client’s ability to engage and relate and music, and musical considerations would have to be implemented based on each client’s individual differences, yes, I completely understand that, and I employ that idea into my own clinical work everyday. In the end, however, when crafting the goal plan, why do we not refer to only musical domain areas? Isn’t that the area that no other profession can claim? Isn’t that what separates us and makes us valuable on a treatment team that already consists of therapies focused on motor, speech, etc.? Why is our treatment plan not based on the musical?
To that end, my next questions are:
1) Are back-and-forth affective and robust interactions necessary for social-emotional development through the span of life (there are different levels of this, based on development. Adults require the same, just with more reflection, introspection, etc.)?
2) Can music therapy experiences, purely in the musical, facilitate back-and-forth affective and robust interactions necessary to engage in a range of musical experiences?
3) Can engaging in a wide range of music therapy experiences, purely in the musical, provide back-and-forth affective and robust interactions necessary for social-emotional development?
4) In your clinical work, in attempting to provide your client with the support that may facilitate robust interactions, where “is” your client musically? What is his/her musical process in the context of relating? What is the musical process between you (therapist) and client? What does it sound (uses only musical terms)? And, what would it sound like if he/she were able to accomplish this musical goal (using again, only musical terms)? Furthermore, what would be your musical objectives that you would implement in the treatment plan, in thinking developmentally, that may help lead your client into accomplishing such a sophisticated musical goal?
So, in determining your responses to question 4, wouldn’t the clinical goals musical goals? Wouldn’t your interventions and objective also be musical Yes? No? Maybe? If yes, why? If no, why? If maybe, why?
I would love to other chime in and share their ideas.
Thanks for reading!
Best,
John
Go read my paper on Developing Music Therapy Goals and Objectives, and then you’ll see what the story is, could, or should be.
Hi Dorit,
thanks for your reply in guiding us to your work and your perspective. The point of my last entry, for me, is not to find what “it” should or could be, or what it could be; as we all have valuable ideas and thoughts that should be respected and viewed- that’s how we learn and grow as a profession. For me, the point of this blog post, is to connect with others and discuss some FOUNDATIONAL thoughts on how MT’s view musical and non-musical goals. This is foundational and rudamental to how we work and communicate as music therapists. I’m sure many us have us, including myself, have very involved and detailed assessment processes; however, personally speaking, what’s important is how each of us came to the or A conclusion. Answers, for me, come through my expereinces as a person, student of the work, and and as a therapist.
Thanks again for reading
John
Hi John, I enjoy reading your blog posts. I am a long time music educator and but very new to the profession of music therapy. One of my biggest hurdles has been putting things into ‘clinical’ terms. I decided to pursue a career in MT because I knew firsthand the therapeutic quality of being in music (with and without the ‘other’ relationship) and was interested in music’s ability to help people in non-music-domain-issues.
I’ve really enjoyed reading Kenneth Bruscia’s writings on aesthetics in music, and am especially curious about what the scientific community is continuing to learn about music and the brain, and the effect music has on us developmentally. I am also keenly interested in the field of Positive Psychology and wrote my thesis on if and how it can help MT’s in our work with kids with autism. There are just so many places that I would love to draw a line that are not where society currently draws the line. However, we are a cost-driven society, so no matter what our own motivations or justifications are for wanting to put musical goals and objectives on treatment plans, I think it is risky until we have the evidence that certain musical domain goals will directly help the client with whatever problems they are trying to address, which in all likelihood are not music related, we need to stick with working in ways that will get us paid (and earns us the respect of other clinical communities),
I am currently developing a program in a school for kids on the autism spectrum, and I am their first exposure to music therapy. When hired, I was told that I needed to follow the National Standards for Music Education and have my certification in music ed. I hated to tell them that my master’s in MT trumped that, but hey, a job right out of school is a good thing. So while I do have some broad musical goals, I am still always working on clinical goals.
I found that AMTA’s book on Effective Clinical Practice in Music Therapy: Early Childhood and School Age book does a good job of discussing the use of musical goals. But in life, if people have musical goals without clinical issues, there are a lot of music teachers out there! The community music school where I also teach has a thriving ‘New Horizons’ adult band, and there is no doubt in anyone’s mind that the people there are benefitting in ways beyond the musical through their participation.
I do like that you raise these thought-provoking questions! Hope I didn’t ramble too much!
Virginia Macdonald, MA, MT-BC
Virgina, thanks for your post. I’m very interested in your thesis on Positive Psychology, and will try to check it out!. Here, I wish to respond to your statement:
“However, we are a cost-driven society, so no matter what our own motivations or justifications are for wanting to put musical goals and objectives on treatment plans, I think it is risky until we have the evidence that certain musical domain goals will directly help the client with whatever problems they are trying to address, which in all likelihood are not music related, we need to stick with working in ways that will get us paid (and earns us the respect of other clinical communities)”
If, as you claim, the problems the client is trying to address, are likely not music-related, then we are (as many describe music therapy) “using music to address non-musical goals.” My primary question here would be: If so, then what differentiates us from any other healthcare professional? It cannot be solely the use of music itself, as I know many other healthcare professionals who address the health domains indigenous to their disciplines through the use of music. And yet they are not music therapists–but why not? What is it that actually differentiates the scopes of expertise, if both are dealing with the same “Point A” and “Point B”? It seems that has always gotten MTs in “hot water,” when they try to assert that MT does the same thing that you do, only better (many experimental studies in MT are set up this way, in fact–to demonstrate the “better” utility of MT over another modality in attempting to accomplish the very same outcomes). I don’t actually see how this is a case for MT at all, and it certainly has neither earned us the respect nor the pay (!) I believe we should have, by this point in our profession’s history (60+ years).
Alternatively, if we, just as other disciplines do, focus on the particular area of health that we address with greater expertise than any other–namely music–we no longer find ourselves in a “turf war” with other professions. Instead, we bring something needed to the table, that no one else is bringing, without having to “show someone else up” in the process. Moreover, we demonstrate how we are not “adjunctive” to someone else’s discipline (i.e., speech, PT, neurology, psychology, etc.), but are equal partners and stakeholders in a healthcare team. As such, our payscale could naturally be higher.
I speak not abstractly on this matter, but from direct experience. Whenever I have marketed MT services in clinical settings as addressing a dimension of human health that is unique (rather than emulating another), I have received the best reception, the greatest respect from other professionals, and the highest pay. Demonstrating the unique value and significance of a service is key to generating fair remuneration for that service. This is actually a well-known principle of good marketing!
Returning to the issue of the music-relatedness of health concerns: Herein is PRECISELY where the music therapist’s expertise may be understood as “located.” As MTs, we are capable of contextualizing health not as something separate from music, but AS music. We, as MTs, are uniquely able to demonstrate, relatively instantly, how a more musical gait is an improved gait for a person with a stroke, how more expressive music-making is improved affect for a person with depression, how greater relational spontaneity in musical play is transcendence of the interactive limits and rigidity found in persons with ASDs, etc. And here, music is not limited to a sound-based phenomenon, but is one’s capacity to function aesthetically in time (most clearly and concretely demonstrated in sound music, but not limited to it). These musical outcomes are not merely “analogues” or “synonyms” of how other disciplines would describe clinical improvements, but are a unique forms of clinical improvement, across particular health concerns–with immediate, clear, compelling “evidence” that they are indeed occurring. Moreover, just as we appraise art, literature, or anything else in the realm of the humanities, we use humanities-based value constructs, which is based in meaningfulness, coherence, social impact, etc. (we don’t appraise music by how many notes are in it, for example, but by its significance, in human social context–likewise, health as music in music therapy may be understood along similar lines…and while we can certainly count, measure, etc., those measurements are not particularly relevant to the domain of health being addressed–i.e., the musical).
If we cannot describe the processes and outcomes of our work in terms of the music that we have all cultivated so judiciously over our years of training as health-centered artists (or art-centered health care professionals), then what is really the point of all that training? It’s time to un-dichotomize music and health, and find the means of articulating and conveying the legitimacy and rigor by which music itself promotes and embodies a particular domain of human health–one that spans the range of bases for the various referrals to therapy (and one clearly worth its weight in gold, if not in reimbursable health care dollars!).
If this sounds like fantasy, I would counter with the supposition that the true fantasy may be that music therapists can continue to masquerade as PTs, psychologists, behaviorists, who “happen” to use music, and actually gain the respect they seek as a viable profession.
Thanks for listening,
Brian
“If we cannot describe the processes and outcomes of our work in terms of the music that we have all cultivated so judiciously over our years of training as health-centered artists (or art-centered health care professionals), then what is really the point of all that training? It’s time to un-dichotomize music and health, and find the means of articulating and conveying the legitimacy and rigor by which music itself promotes and embodies a particular domain of human health–one that spans the range of bases for the various referrals to therapy (and one clearly worth its weight in gold, if not in reimbursable health care dollars!).”
And therein lies the challenge. I think so many people’s experiences of music are as background or entertainment.
Exactly, Virginia! That is indeed the challenge. And who better than us to meet that challenge, and work toward raising the public’s awareness about what musical health really is? Isn’t that squarely in the center of what we consider to be “advocacy” and “education”? Hopefully, advocacy doesn’t only consist of justifying what we do in terms of the often limited views of music out there, and of maintaining the age-old means-end dichotomy wherein music is little more than a skillful means to non-musical ends.
Hi Virginia,
Thanks for your thoughtful post and for participating in this back-and-forth- much appreciated!
I completely understand what you’re saying in regards to financial concerns. That’s always an issue. Speaking from personal experience, I have found that by discussing a client’s musical process to his/her parents, interdisciplinary team, and school district coordinators that they completely understand how MT facilitates health in musical experiences; which in turn does bring up the value of what we do, financially. To that end, I have created many first time music therapy programs through the result of marketing and promoting MT in a music-centered manner in a variety of settings; and I can honestly say that, financially, I have been compensated VERY fairly ( I would never “low-ball” myself financially).
In addition, recently within the past 2 years or so, I have employed a new assessment tool that I developed. It profiles clients musically. Basically it targets musical domain areas of musical responsiveness, and breaks down the different aspects involved in music making into levels; making the process easy to see (graphically) and understand. This tool has been presented by my colleagues and me at several IEP meetings for children that we work with at our Center. The purpose of the meeting is help families get MT on their child’s IEP as a related service. In short, we go into these meetings with our client’s musical-emotional profiles and discuss the child musically within the context of relating and communicating (after all, those are the core deficits of ASDs). I am happy to say that each time that we have been invited to speak to a child’s IEP team, not only was the family awarded music therapy at least 2 times per week (as a related service), but the district also permitted us to offer our MT services at our Center (generally, in NY, related services must be offered at the child’s school).
In addition, at our music therapy Center, in which most parents pay out of pocket, we provide sessions Monday-Saturday and are completely full (a lot of referrals come from the school districts as well as other disciplines). We meet with parents regularly in order to help them understand how we work within the context of their child. In doing so we incorporate our music-centered assessment tool and vocabulary in our parent meetings, and the feedback has been incredible, such as, “oh, now I understand what you’re doing!” or, “oh, this makes so much sense. I completely understand how these goals are geared towards…” I can go on and on. Education is the key- having the consumers understand and value what we do, while coming to the realization that, like other disciplines, we offer something that’s special, and, it’s indigenous to MT.
One last thought comes to mind: In a way, the DEMAND for music therapy that incorporates musical goals within the context of relationship is high, because the SUPPLY of MTs who work in this manner is low.
Thanks for reading and dialoguing!
Best,
John
My own answer would be YES, music therapy goals and objectives certainly can (perhaps even “must”) be musical, particularly if we adopt an understanding of music as something beyond a concrete sound object (i.e., relational, aesthetic time.
Understood this way, the entire relevance for the “clinical” in music therapy is “located” in the relational, human-musical dimensions of movement, speech, thought, feeling, etc., which constitute the very basis for clinical referrals to music therapy by others. The role of music (and musicking) here is to provide opportunities for appropriation of the unique personal and social resources that shared music experiences represent, and to provide possibilities for new, more aesthetically integrated ways of being as persons (whether we are talking premature neonates, children with ASDs, adults with psychiatric diagnoses, or persons at the end of life).
In this sense, music therapists do more than getting the client effectively from the very same point “A” to the very same point “B” specified by another discipline, but using music (in place of medication/physical interventions, behavioral interventions, etc.)…they address goals and objectives within a domain of health that pervades all of the dimensions of health, yet which is endemic to the discipline of music therapy.
Brian
I think the criticism of this idea that musical goals are clinical goals stems from the fact that not everyone agrees with the premise that by working with a persons music you are working with a core aspect of the persons personality. Many do believe this, but some do not, and simply see gains made in music making such as more organized drumming as improvement in a musical skill but not recognizing the deeper significance. I have also seen some clients develop their musical skills and relational abilities playing with the therapist but not carry that over to relating without music and thus made clinical adjustments accordingly. But I think as music therapists it makes sense to start with the premise that if we do work with a clients music it has great potential to have clinical meaning and significance for them as a whole person.
Absolutely agree, Alan. In fact, it raises the all-important question of context. It’s funny how, from a certain point of view, changes in the musical domain “don’t matter” because they don’t “generalize” to other areas. For example, when someone with clinical depression demonstrates improved affective range through working in music, in the form of expanded MUSICAL expression, and even though this very act itself CONTRADICTS the DSM-IV’s symptomatic definition of depression, it “doesn’t count” unless it can also be demonstrated in the interview room with the psychiatrist. Well, I don’t know about you, but in many of the cases of being in the interview room with a psychiatrist as a team clinician, I haven’t felt like being particularly expressive, affectively. The conventional “snapshots” of people in certain contexts are not necessarily evidence against their health–yet, even a tiny “snapshot” of someone contradicting a diagnosis, even in one context, can be enough to challenge the entire diagnosis itself. Even one moment of aesthetically connected relationship in the music room makes the claim that a person with a neurodevelopmental issue “cannot relate socially” false. They can. The question of “generalization” is therefore just as much a question of how contexts can shift (the home, the classroom, the medications, etc.) around the client, as much as it is a question of how the client needs to assimilate into contexts that do not support the client’s health (which, in a sense, moves us into the realm of Community Music Therapy). Is it really so outlandish to suggest that making the world more like the music room is part of what is “good” for our clients’ (and our own) health?
I think first and foremost-the person is the evidence. All change counts. How can we orchestrate meaningful ‘transfer’? Next, is the ‘context’-the culture-family and school-job (psychosocial transfer of our goals-no competition if we are all doing our homework and linking jewels of all of our ‘multi-disciplines’….) and then also the ‘intra’ lifeworld of the person (purposefully not saying ‘patient’ or ‘client’ here) and therapist. So nice that ‘diversity’ conf is coming up at Molloy. The third word that is a light of many hues for me is ‘musical’— I like ‘music’ better-‘musical’ may be misunderstood and mis-leading. As far as ‘depression’-nice new interesting article in ‘Music & Medicine’ just released on research from Finnish MTs on perception of music and affect related to content and feeling. This is a nice blog John. Mourning the miss of your conf and perhaps getting some here to supplement!
After what we spoke about in class I had to take a peek at this. I have to admit I was skeptical at first about music centered goals. I like many others felt it would alienate the profession. In the long run Ive come to realize that it would only legitimize what we do. We need to be the experts on “healthy” music. It may confuse others at first but that is precisley why they need us to explain it to them. If they don’t need us to explain it to them than what the heck do they need us for? Speaking in very basic terms I think an outsider may think we are trying to make in individuals music sound “good” when really we are trying to make it sound “healthy”. If I am correct in saying this, its not about the aesthetic quality of the music but rather the interactions that take place with in it? This is all alot for a new professional such as myself. However if I don’t try to get this now, when will I plan I doing it?
Michelle,
I think this depends upon whom you talk with about this. Some don’t differentiate between “aesthetic” and “healthy” when it comes to the music. However, what they often mean by “aesthetic” is not the same as what is generally meant by formal performance practice. The Nordoff-Robbins people are fairly clear about this, and have articulated and demonstrated it in numerous different ways. The musical IS the clinical from the N-R perspective (as I understand it), but the musical is not assessed according to performance practice standards, but by clinical/contextual/client-centered musical standards–this is INDIGENOUS to music therapy…something many find hard to understand. It’s a way of understanding music itself that music therapists “get” in a way that others, without the MTs particular training and competence, does not “get.” I, myself, agree with this perspective, except I would expand the notion of “music” to dimensions beyond a conventional understanding of music as expressed in physical sound, but I would still submit that music is our primary domain of health, as it manifests across and within all other domains of human health/functioning.
Nice blog and good questions! Brian I like your thoughts on generalizations including a changing of context as well as being able to performan across different contexts. It reminds me of the TS of SCERTS model.
Michelle I also like your thoughts on healthy music versus good music.
John thanks for sending me your dissertation months ago. I really appreciate it and am slowly digesting it. I’m interested in the assessment you mention as well. Is it on the market yet?
Personally, I think of two students I have worked with recently. In these two sessions I often use music constantly the entire session. One boy increased his musical expression beyond an obsessive playing of one pattern to be able to play a variety of good sounding duets with me. The other girl has used music to be more emotionally regulated, gain meaningful expression through a musical give and take process as well as learn new music. Both these sessions use improvisation and a type of intuitive responsiveness from the MT. Both children are among the most musical of the kids I work with as well. Both are very highly motivated to attend and participate in session and sometimes don’t want to leave. With these students it is much easier to think of meaningful music goals that are also clinical. It is a bit difficult to track how their new skills could be evidenced outside the session. I think some treatment models measure skills outside of the clinic more than others and this may be something to consider.
I have other students who are less musical and yet still very responsive. Perhaps i should differentiate between expressive musicality and receptive musicality in these case. These students tend to do better with using PECS or by using music to assist gait training or perhaps use more AAC. All for now, I’m enjoying the discussion. Peace!
Dr Carpente
I would be very interested in seeing your musical responsiveness assessment. Is there special training for this? Is there a way I could see or purchase an assessment like this to see if it would be of value to my practice?
Hi Antoinette,
Thanks for your interest in the IMCAP-ND. I’m currently in the process of publishing it in the form of a Clinical Manual. I’m hoping for it to be in print by Dec or Jan. Yes, there will be a training once the book (Manual) is complete. The training is scheduled for the spring of 2012.
Best,
John