Hi all,

I just began thinking again about a topic that usually finds its way into my work as a clinician, clinical supervisor and educator: How do music therapists define health? Is health defined in and through the music, in musical terms? if so, what does that mean? How does that help define what we do as therapists? If speech therapists work to “fix” the speech and language of clients, and physical therapists work to “fix” the motoric abilities of clients, do we as music therapists work to “fix” the music of clients? if so, again, are we defining health within musical contexts? For example, when a client expands his ability to be related in music with his therapist, or develops his/her ability to intiate expressive components in his/her drumming (range of dynamics and tempo) while engaged in musical play with his/her therapist is this health? if so, how does health sound? how does pathology sound?

Would’nt it be interesting if there were musical profiles that identified specific client groups? Meaning that pathology could be identitifed through a person’s music. hmmm…again, what does health sound like?

OR

Does the music therapist define health in ways outside of music?  i.e. identifying health in terms of physical, social, behavioral and emotional realms that are outside of music? Is that possible when music and musical interaction embody all of the above?

And finally, in viewing many assessments, it appears that music is generally listed as one of several domains, including social; communication; physical; emotional; etc. Shouldnt music be the only domain? why? why not? I’m thinking that if health is defined outside of music, why is it (music) even assessed? AND/OR , if health is defined musically, why are other domains, outside of music, being assessed? AND, are we even qualified to do so…

I’m hoping to create some dialogue on this topic for those who are interested.

Thanks for reading!

Best,

John

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About drjohnmtbc

John A. Carpente, PhD, MT-BC, LCAT, NRMT, Assistant Professor in Music and Music Therapy at Molloy College, is the Founder and Executive Dir

14 responses »

  1. Brian Abrams says:

    John,

    GREAT topic! Thanks for posting.

    I’ll respond simply by sharing a quote from something I wrote for Voices back in April. I was writing about a view of music therapy as “musical therapy,” meaning that what identifies the practice and its goals (i.e., how music therapists look at health) might be distinguished from other professions in that they are rooted in music. From this view, music is a distinct domain of human health that is neither isolated from all of the other domains, nor is it merely a “translation” for the others:

    “…From these perspectives, the goals are understood as musical, in that music can be viewed as an expression of health itself. Achieving new ways of being in more broadly and deeply musical ways relate to other domains (i.e., the depth, coherence, meaningfulness, and beauty expressed in aesthetically integrated movement, speech, thought, feeling, communication, etc.). In the simple act of expanding one’s capacities for musical experience and play in particular ways, beyond one’s previous limits to these capacities, one has shifted something fundamental about one’s being, relevant to numerous other domains of health and the bases for the initial music therapy referral (or self-referral). Yet, at the same time, there is something in music that transcends those other domains. Just as any health domain cannot ultimately be reduced completely to any of the others, music as a health domain holds its own intrinsic legitimacy and meaningfulness as health, independently of what it signifies with respect to other domains—and it addresses dimensions of a person not necessarily articulated by the referring discipline.” (Abrams, 2010)

    Abrams, Brian (2010). Musical Therapy? Voices: A World Forum for Music Therapy. Retrieved January 27, 2011, from http://www.voices.no/?q=colabrams050410

    • drjohnmtbc says:

      Hi Brian,
      Thanks for your thought provoking comments. music as a health domain, in my expereince, is something that appears to be diminshed or not looked at (values) as A DOMAIN. For example, when you look at MT assessments, most include music as one of several domains (i.e. cogniton, communication, etc.), however, it doesnt seem relevant. In my thinking “it” (music) seems out of place. I say this because, for me, music should be the ONLY domain, or not listed at all.You’re either vieing music as health, or your not. If your looking at social or cognitive aspects, then, that’s what you’re looking at because that is what you are valuing as important??? If we are looking at “it” (music) as health, and we know that it emodies all other domains (i.e. social, communication, etc.)why ar we looking outside of our discipline (assuming that we see music as health)?? if the MT is assessing domains outside of music, why even look (listen) at music? it appears as though, in my perception that music is just a “throw” in, like a “B” side to 45 record (a filler). Does that make sense since this is the essence of what we do? That IS our identity. It’s who we are as therapists (Our filed appears to have an identity crisis. why? we know what we do, it’s the name:MUSIC THERAPY. We “utilize” music! And if we “utilize” music, shouldnt that be the essential component? should music be the thing that we are evaluating? yes??
      This brings me to another point: eveything in this blog, including all of the great comments by all of you, depend on your how therapy is viewed and practiced. In other words, a therapist working in a relationship-based manner is focusing on different aspects then someone working behaviorally; so of course music will be “looked” at diffrently between the two. I would imagine that our orientation, in how we practice, determines how one define’s health. And, if we take this a step further, defining how we define what therapy (orientation) and health are will determine what we regard as evidence-based research.yes? how can we us the same lens to look at different things from various angles and values. it makes no sense, does it? the way in which we measure relationship in music is very different then how we measure behaviors because we are looking and valuing different things. Baseball, football and hockey are all sporting activities, however, each sport has its own value system because they emphasize different things in terms of what’s regarded as “good” In addition, if we even break it down to one sport, such as baseball, we see that people in the sport (baseball), depending on the philosophy of team, value different stats. For example, there are some that value batting average. so, there is a statisitcal formula that determines what a ball player’s batting average is in comparison to other players, however, some baseball people value on-base-percentage (OBP). so, OBP percentage has a completely different statistical formula and values different aspects of the game and each player involved.
      All of that being said, i think that it’s important to clearly define and link: 1) therapy orietation, 2) health, and 3) how we measure/evaluate the process and progress of the orientation in terms of impacting health.

      Thanks for reading.

      John

  2. Brian Abrams says:

    An additional comment (in response to one of John’s questions):

    Yes, in music therapy, music can (from a certain perspective) be understood as “THE” health domain. However, this requires expanding our understanding of music. We need to understand it AS health–as a dimension that permeates everything else that we are and do, in a particular way. It must be seen as an “end” in itself, beyond a mere “means” to other, conventional health domains…and it must be seen as as “end” unlike that of music education (i.e., the capacity to create/perform music as an art and/or entertainment process and/or object). Were such an understanding of music possible, then by “treating” a person’s music, one would be treating all of those aspects of a person, in a particular way, that only music comprises. And this skill of “treating” a person’s music would belong within the realm of the music therapist’s unique, indigenous expertise.

    Thanks again for posting on this very important topic!

    • drjohnmtbc says:

      Hey Brian,
      thanks for your PS…
      it kinda ties into my response to your original post.
      You mentioned:”Were such an understanding of music possible, then by “treating” a person’s music, one would be treating all of those aspects of a person, in a particular way, that only music comprises” I’m not sure if “all of those aspects of a person” are impotant, if we are treating the client’s music (i’m assuming that “all of those aspects of a pereson” means other domains); looking at musical processes as the clinical processes…this is a question that i commonly struggle with. I find myself going back and forth; holding on the one to justify the other (part of it is that i find it easier to explain to folks (students, clients, parents of clients, etc.) when i tie in “other aspects of a person” with the musical aspects

      Thanks,
      John

      • Brian Abrams says:

        John,

        Thanks for this follow up. I suppose what I am proposing is an expanded view of music itself, such that treating a person’s music is not just treating what they do in the musical sound realm, but treating their musicality within all of the domains of humanity. The sound music realm is an ideal “window” into all of these areas, but my point is that music therapists can be working musically with a person’s music EVEN WHEN they are not making sound-based music.

      • drjohnmtbc says:

        Brian,
        thanks for you thought provoking comments. In your recent post/reply you mentioned: “but my point is that music therapists can be working musically with a person’s music EVEN WHEN they are not making sound-based music” can you elaborate? what does it mean to work with a person’s music, whan they arent making any?
        Thanks,
        John

      • Brian Abrams says:

        John,

        Thanks. To clarify, I referred to “sound based music,” not “music” itself. While the conventional view does not differentiate between these, if we do not limit music to a physical sound modality, either in the sense of Boethius’s (1989) way of locating human music in Musica Humana (the level of music endemic to the aesthetic integration and “health” of humans and humanity itself) or Zuckerkandl’s (1956) way of locating music as a temporal-aesthetic experience beyond the sound that may help convey it, we can grant that people manifest musical dimensions in all aspects of their humanness, and that the musicality of those aspects is a musical way of construing their health. For example, the pace, flow, and coherence of my movement or speech are temporal-aesthetic dimensions of those aspects of my functioning that neither physical therapists nor speech-language pathologists are likely to comprehend as a music therapist would…and yet, these aspects of both movement and speech can be a significant part of the basis for the referring “problem.” This would not supplant what the other professionals would do in response to these problems–rather, it would, in the truest sense of the concept, complement what they do, and bring something unique and necessary to the healthcare team’s “table.” If looked at this way, as Pavlicevic (2004) adeptly observes, a music therapist need not be “doing” in the concrete, physical modality of musical sound to manifest their core, musical-clinical sensibilities–I can apply my unique training as a music therapist in the ways that talk, move, and relate to my clients, in the interest of helping them to develop their human musical health, whether or not we happen to be making concrete, musical sound in the process. This is not to diminish the unique importance of musical sound as a privileged conduit and “window” to human music, nor the importance of the study and competence in musical sound as a unique means of understanding the more fundamental, primordial, human music–it is simply a way of “re-locating” music in a way that helps reconcile some of the dichotomies we have seen in music therapy to date. For example, the idea of “using music for non-musical goals” (common view) or “engagement in musical sound, or musicking, as a clinical goal in and of itself” (current literature on definition of the “music-centered” view).

  3. Michael Viega says:

    Great points Brian. I know working with teenagers who have seen and experienced multiple traumas, and consequently are now dealing with the psychological, behavioral, and emotional side effects of their childhood maltreatment, one of my primary goals as a therapist is to guide and help increase their musicality. Within the context of the musical relationship, the teenager for the first time in their lives may have an experience of being musical. While musicing, they are not the “troubled teen” whom mostly gets pigeonholed in terms of their past mistakes, nor are they the “product” of some social, political, and economical neighborhood dystopia. Instead, their resources shine. They can try on and live through new identities, practice and develop deep listening, play, laugh, experience flow and be musical. If recording, they can then play back and re-experience this moment in time; a moment when the clinical “problem” was bypassed and their goodness shone through. Hopefully, this is a small step towards for their transitioning into a productive healthy adulthood.

    I often thought about the question, “does health have a sound?” I remember hearing about the studies where heavy metal music withered plants, while classical music allowed those plants to thrive. Well, as a teenager I listened to Master of Puppets by Metallica many many times…and I think I turned out to be a pretty well adjusted adult (I think!). For me, musicing exists outside of such causality.

    I was reading the latest issue of Wire magazine and saw a wonderful quote that speaks to this issue for me. Hassan Khan, an experimental musician speaking to the experience of live improvisation stated, “to be sure, when the conditions are right, all other considerations fall away and the only thing that matters is the emerging dialogue between sound and process, moment-forms and the trajectories they shape over the duration that binds audience and improvisor in a mutually rewarding contract of focused playing and composerly deep listening.” (Bohn, 2011, p. 4). If we took out the words “audience” and “improvisor” and added in “client” and “music therapists”, there is something about that quote that sounds awfully related to music therapy process to me.

    John, once again, great questions. Thanks for getting me thinking about it more! I am going to go put on And Justice for All for old times sake!

    Source: Bohn, C. (2011, February). The Masthead. The Wire, 324, 4.

    • drjohnmtbc says:

      Mike,
      thanks for your thoughtful post. You said, that you commonly think about “does health have a sound?” And now in thinking about this, I’m not sure if health has a sound. I dont know if w can reduce all of the musical processes to a sound??? not sure. Does that mean that that sound is healthy for all people?
      im thinking not so much about the product of sound, but the process between 2 or more people making the sound (music), and all of the musical-relational-dynamics involved in the musicing between client/s and therapist. I also used to work with at risk youth. At times i would incorpate several music therapy methods depending on the clinical situtation (i.e.improv, songwriting and/or song discussion); however, sometimes it would take weeks before they would even “allow” me into their music world. I remember a client who would come into sessions and just sit behind a drum set and not do anything, just sit there for the entire 45 min and stare at the ground while keeing his coat on. Then, one day (of course I’m leaving out a lot of details but this is the jist), music making occured. That music making making would have never occured without the weeks of silence, or musical rests (if you will). Was our musical sounds healthy? hmmm… was they way we made music healthy (utilizing all of musics dimensions)- I think so.
      I dont think that we can isolate musics, or reduce “it” to certain sounds that determine healthy, as opposed to the musical-dynamic occuring in the musical space between client and therapist- looking/hearing the quality of the music making process. That being said, i feel that some clients are more musical then others, however, that shouldnt determine that one’s more healthy thn the other. i think that it’s all relative as I’m looking at the quality and depth of the musicing expereince. Many times I have expereinced client who are VERY musical. They have an easy time using music to keep the world from them. They are so musically aware that they know and understand how to manipulate it to isolate (it makes sense, if we use music to connect, mwe can also use it to disconnect, no? we can’t have on without the other??). to that end, we can be invloved in musicing, it will sound great, however, nothing is happenning…kinda like musak- but that’s another blog:)
      Thanks, Mike

      John

  4. Brian Abrams says:

    Great points by Mike…and very useful source material. Thanks!

  5. Tania Kendrick says:

    Great questions! And very thought provoking responses.

    To me I have to start making some distinctions in my mind between development of musical skill and development of natural musical response (as Elizabeth Schwartz talks about in her book) and of course the difference between a developmental delay and a developmental disturbance. In my field (Early Childhood Special Education) we talk about disturbance and delay and not pathology–so that’s why I am using this–in blocks to health and healing,growth and development.

    Is the development of Health based on skill development or a motion toward the further development of natural musical responses into one’s own “music”/self? I am a member of Music for People, an organization that cellist David Darling leads and it teaches free music improvisation for an entire community–ways for the inexperienced player (even the fearful one!) to play with the very experienced. We all have something to offer each other. It is based on the idea that music is our birthright. And I remember David at one workshop giving us a funky rhythm exercise encouraging us to walk around and find our own groove in that moment. That was revelatory!…that music wasn’t just for people who defined themselves as professional musicians but is in fact is a primary way to experience, explore and express one’s self. A lack of health to me is having that inner call to music and/or expression/connection to Self but not knowing how to respond to it. This then can cause a psychic disturbance and maybe pathology. (This could be a chicken and egg thing too!)

    To me health–and it is definitely not a static thing more like a daily spectrum thing–is being able to connect to my groove, my free improvisation and as much as I can help my students to connect to theirs and as M.Viega said let their “resources shine”, their self. It is absolutely remarkable for me to see this in 3 or 4 year old with Cerebral Palsy or ASD and how that connection gives them elemental fuel/a sense of agency from which to go through their day full of so many challenges.

    I’ve also been reading Effortless Mastery by Kenny Werner and Free Play by Stephen Nachmanovitch and both of them talk about connecting to this sense of “play” and Self through music and that to me is health too. Stephen Nachmanovitch even discusses Winnicott and his idea that healing is going from a state of not being able to play to being able to play. Child development is full of references to how important play is–I spend alot of time trying to teach children how to play–but we don’t talk about how important it is as an teen/adult. I resonate with the necessity of “play” and what it offers–an arena to work out ideas, feelings, sensations, and experience of Self alone and in a group/community and often fun–as an important aspect/experience of Health.

    Thanks!
    I look forward to reading more responses.

    • drjohnmtbc says:

      Hello Tania,
      Thanks for your comment. I like the comment that you made in regards to groove and possibly identifying health with being in groove with clients- helping your clints connect to their groove. i too think that’s important. as we help or guide clients into finding their own groove, we hope that they will assimliate this and invite us into their groove (initiating music ideas with the intent to relate and communicate within the context of musical-play); and while being in their groove, having this wonderful back-and-forth of musical dialogue, deepening the musical expereince (incorporating a wide range of musical elements and expanding the play). i think we are trying to help them expand their range of groove that encapsulates the emotional qualities of music (leading to expression and creativity with another)They take this new learned groove and musical awareness into the world. isnt the world all about grooving with others?? i think this is very music ties into community music therapy, too!
      thanks,

      John

  6. Michael Viega says:

    Tania,

    I like your discussion on groove and health Your experience of groove was obviously a transformative experience for you. For me, helping people groove can be a legitimate clinical goal in music therapy. As a musician I feel that the experience of groove can be healing, just as you experienced. i think about highly disorganized and scattered psychiatric patients, who, while in a music therapy group, organize themselves in an improvisation and experience having a moment where they are part of the whole but unique as well. So, going back to John’s question, I certainly see health within that musical lens. I am sure someone from another field may see and talk about that phenomenon differently, (one can view groove in terms of behaviors,having a peak experience, or wanting to symbiotic with mother!) but coming from music I feel most comfortable viewing it through the lens of the musicing experience, such as being in the groove.

    • Brian Abrams says:

      Great discussion!

      I wish to comment further on Mike’s comment:

      “So, going back to John’s question, I certainly see health within that musical lens. I am sure someone from another field may see and talk about that phenomenon differently, (one can view groove in terms of behaviors,having a peak experience, or wanting to symbiotic with mother!) but coming from music I feel most comfortable viewing it through the lens of the musicing experience, such as being in the groove.”

      I would argue that, while people from other fields could describe health in different terms, I believe a term such as “groove” is really indigenous to music and, when applied to health, to music therapy. Put another way, when “groove” is construed and observed in contexts not involving conventional “sound forms” of music, I believe we’re still describing health musically, and hence in a music therapy context that is unique to the expertise of the music therapist. While many might “get” the analogies between sound forms of music and so-called “nonmusical” response, I believe music therapists are uniquely equipped to construe human health itself musically, whether actually involving musical sound or not.

      Thanks again!
      Brian

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