Hello friends! Continuing with this series of guest bloggers, I’m happy to introduce friend and colleague, Dr. Brian Abrams, who has written a terrific post entitled: “Ways of Thinking Musically in Music Therapy.” Thanks Brian for sharing your thought provoking ideas!
Ways of Thinking Musically in Music Therapy
In November 2011, at the annual conference of the American Music Therapy Association in Atlanta, Georgia, Dr. Kenneth Bruscia, the William W. Sears Distinguished Lecture Series Speaker, delivered an outstanding lecture entitled “Ways of Thinking in Music Therapy,” in which he examined different perspectives on understanding the practices and purposes of music therapy.
Dr. Bruscia, who was the most central mentor in the development of my professional identity as a music therapist, has always inspired others to think deeply about themselves and their work. For me, his guidance always prompted the question: What makes the work of a music therapist special and unique? Or, in other words: What differentiates it from other disciplines and professional practices? … or … How can we “locate” it, conceptually, as a specific construct? This was more than a mere intellectual exercise–it held a certain sense of urgency (at least for me) in understanding and advocating for the non-replicable value of music therapy in serving clients and the public via our modality.
For me, these questions were never adequately answered by considering the procedural components of music therapy alone, as popularly described. For example, it was not merely the use of music in a health promotion process that defined the distinctive essence of music therapy for me. Other health care professionals could certainly utilize music in their work, as part of facilitating various therapeutic outcomes–and yet they are most definitely not music therapists. Likewise, I had experienced music therapy sessions (both in the role of therapist, and as client) in which no conventional sound-forms of music were employed, and yet the work was most definitely music therapy! What could possibly make this so, even in the absence of musical sound? I have not found an answer to this question amidst the items included in the Certification Board for Music Therapists (CBMT) Scope of Practice. While the Scope of Practice itself is quite comprehensive, and most certainly is unique as an aggregate list, it is not immediately clear (to me) that any given item in that list is exclusive to the field of music therapy (even though that item may not appear in scopes of any other profession, with quite the same wording).
Just as procedural components did not resolve the elusiveness of music therapy, qualifications and credentials did not seem to help either. Completion of training in an approved academic program does not necessarily render everything one does “music therapy”…one needs to express one’s acquired expertise in the field, intentionally, and in a certain professional context, in order to be actually doing music therapy. What was the qualified music therapist doing at these times, to make the practice “music therapy”? While the knowledge, skills, and abilities specified in AMTA’s Professional Competencies are of paramount importance to the integrity of the music therapy field, the qualifications that allow the music therapist to do what she/he does is not the same as understanding what she/he is actually doing, when she/he is doing music therapy.
The more I sat with this, the more I realized that it was neither a set of procedures nor a set of qualifications; rather, it was a particular way of being, guided by a particular way of thinking, that ultimately distinguished music therapy on an essential level. While any healthcare profession has particular ways of construing health and health-promoting processes, only in music therapy are these intentionally construed musically. Only a music therapist is fully equipped to understand the health implications of being-with others via musical, dynamic forms in time–even in the absence of conventional, musical sound. Thus, it is not a question of whether or not musical sound is used within a therapy session–it is a question of how the music therapist’s unique ways of thinking can guide ways of being-with clients in uniquely, clinically indicated, musical ways, all in the service of promoting the client’s musical health.
The music therapist’s unique sensibilities for thinking musically about health and health promotion are cultivated through years of rigorous studies in music, as well as “immersion” in mentored, supervised training environments. Such an “immersion” cannot be replicated via intellectual understanding alone, nor via some sort of analogous training format in another field, as these cannot afford one the capacity to construe either the clinical work (processes) or the outcomes (goals) of that work, musically–at least, not in quite the same ways, and not to the same degrees of competent breadth and depth, as are afforded music therapists.
As music therapists, shouldn’t we manifest these indigenous sensibilities to their full extent, including the ways in which we communicate the nature of the work to others, the ways in which we conceptualize clinical goals, and so forth? Is it really such a stretch that we write motor skills goals, cognitive skills goals, emotional development goals, interpersonal communication goals, etc., in musical terms (e.g., flow, form, phrase, timbre, volume, contour, tempo, meter, accent/articulation, syncopation, range, melody, harmony, iconicity, etc.)? Must we specify that clinical music therapy goals are “non-musical,” simply to differentiate ourselves from the field of music education?
But this is not just about establishing an indigenous music therapy language, or about any other specific set of procedures–it is about the unique ways of thinking that guide us about our formulation of therapeutic processes and goals themselves. To me, our first order of business is to reconcile our own true, unique expertise with the work we do on a daily basis in the “real world.” Once we experience this sense of internal congruence, we manifest our greatest potentials as helpers, and feel most grounded about what we do (and, most likely, are less likely to experience burn out). It is my belief that a greater capacity for articulating and advocating, in diplomatic and accessible ways, would follow quite naturally, and others would come to understand and respect the profession of music therapy in ways we have not yet witnessed. In my opinion, many of us have long strived to do this in a backward fashion–that is, first to seek acceptance by other disciplines and paradigms, and then attempt to understand what we do in terms of those disciplines and paradigms. While there are many theories explaining our field’s struggles with identity, and with our music therapy professional population’s “ceiling”–at least in the USA (somewhere in the neighborhood of 5000 MTs nation-wide for many years), I submit that obstacles, constraints, and our own resistance to embracing musical ways of thinking in our work is at least ONE significant factor in the equation of our field’s development.
Please share any thoughts (musical or not!) in response to what I’ve shared here. I genuinely appreciate any feedback and/or dialogue others care to offer on this topic.
Musically yours,
Brian
Bio:
Brian Abrams, Ph.D., MT-BC, LPC, LCAT, Fellow of the Association for Music and Imagery, has been a music therapist since 1995, with clinical experience involving a wide range of populations. Dr. Abrams completed undergraduate studies at Vassar College and SUNY New Paltz, and graduate studies at Temple University. Prior to his current position at Montclair State as Associate Professor of Music and Coordinator of Music Therapy, he served on the faculty at Utah State University (2001-2004) and Immaculata University (2004-2008). He has published and presented internationally on a wide range of topics such as music therapy in cancer care, music psychotherapy, and humanistic dimensions of music therapy. He has served on the editorial boards of numerous journals, such as Music Therapy Perspectives, the Nordic Journal of Music Therapy, and Voices: A World Forum for Music Therapy. His current interests include contributing to the development of the global, interdisciplinary area of Health Humanities. He has also recently helped to create a number of music therapy clinical programs, such as at Primary Children’s Medical Center in Salt Lake City, Utah, and at Trinitas Comprehensive Cancer Center in Elizabeth, New Jersey. From 2005 to 2011, he served on the Executive Board of the Mid-Atlantic Region of the American Music Therapy Association (AMTA), including as President from 2007-2009. On a national level, from 2010 to Present, he has served on the AMTA Board of Directors as an elected representative from the AMTA Assembly of Delegates, and has been selected to serve as Speaker of the Assembly for the 2012-2013 term.
Contact Email:
abramsb@mail.montclair.edu or brabrams@earthlink.net
Dr. John Carpente's Developmental Music Health Blog 
I agree with you. However at times I find it a challenge to think about my goals for my client in “musical” terms. I know this sounds crazy because I am a “Music” therapist! This should be the way I think! Sometimes I have trouble articulating what I would like to see in the music. Rather I may find myself addressing more broad topics such as attention to task, or impulse control, awareness of others. I could sit at treatment team meeting and never mention music once! (not usually but its possible) We really do need to change the way we think in order to show what an invaluable profession we are. Any practical advice for a fledgling MT such as myself?
Dear Michelle,
Thanks so much for reading, and for your very thoughtful, extremely relevant comment/question. I agree with you–it is a challenge–a HUGE one. In our culture, we are generally trained to understand music as a sound object, and as something fundamentally separate from what we think of as health and human functioning. It is challenging to being to understand, in more explicit terms, music as something beyond the ways we have conventionally defined it, and health as having distinctly musical dimensions across ALL of its domains.
Consider the ones you have mentioned: Attention to task, mastery of impulses, and interpersonal awareness. Again, the first question is not necessarily how to use musical language for these, but rather to THINK about them musically–that is, what are the dimensions of these aspects of human functioning that manifest aesthetically, in time? Attention to task may be considered, in temporal-aesthetic terms, sustained expressive intentionality (akin to a legato tone, an extended phrase, a repeated motive, or a full movement). Likewise, mastery of impulses may be considered integration and focus of creative engagement in time (I mention “creative here” because “impulse control” usually refers to NOT doing or NOT being something, whereas persons, from a musical perspective, are more about doing and being, even when quiet, still, and silent–i.e., creating!). Finally, interpersonal awareness is all about aesthetic empathy, receptivity, reciprocity, mutuality, harmony, and role identity (whether in duet for interpersonal dyad, trio for interpersonal triad, ensemble for group, etc.), across time.
Thus, my advice to you is to explore thinking about conventional health goals in temporal-aesthetic terms, without initially worrying too much about shifting the actual language you use (and, of course, don’t get yourself in any trouble by suddenly defying the expected language within the culture of the facility!). However, there may be subtle yet empowering ways of framing conventional health goals in ways that more directly embody your unique music therapy sensibilities of understanding health, musically. Perhaps our language will eventually shift, and perhaps the public’s understanding of music therapy will likewise shift, toward something more indigenous to our discipline’s unique identity–but for now, we may find it helpful/useful simply to explore shifts in our current thought paradigms.
Thank you again for your truly intriguing question.
Best wishes in your work,
Brian
I think the treatment team at the day program for adults with DD like to hear about the music during the meetings. It often breaks up the monotony of talking about tooth brushing and showering skills (though those things are important!). With this post in mind I tried to in stead of say “I am working with Joe to improve his attention to task in music” I said “I am working with Joe to improve the fluidity of his instrument playing”. And then explain why I care about the fluidity of his instrument playing (deepening social interaction with in the music). Reflecting on this I think my co-workers want to hear about the music. It helps show that what I am doing is far more than soothing or a fun way to pass the time at program. Rather, there are things going on in the music that are helping these clients continue to gain equipment for living, even in their adult years.
I’m grateful for both of your voices (John & Brian) expressing such ideas/questions. I believe some of my best work has been with students with whom I’ve developed a greater sense of shared musicality, and involved more empathy. Students or clients with more developed musicality often provide more options of connecting with them in meaningful musical ways. Some studies speak of music being more able to reach those with severe disabilities – I remember one such study on promoting language skills with music. So there are at least two sides to this. I like your mentioning of breadth and depth. On issues of professional identity, How would you define breadth and depth? If one goes on to study GIM, NMT, Orff, Kindermusik are some of these more depth and others more breadth? Does it depend upon the individual MT and with which populations they are working? Also in research would agree we have more variety of studies (maybe more case studies) and less sustained attention on any one track of research? It seems like breadth is easier in both of these areas than depth.
It is possible that musicianship and mentoring also point more to procedures and qualifications isn’t it? Those in academia are validated through research efforts right? I mean maybe there is a difference when it comes to professional identity among clinicians and professors. Is anyone studying music therapy as it functions more with empathy and these type of areas? Sorry, I’m staying late at work the last day before vacation to express whatever scattered thoughts I’ve managed here. I truly value this conversation. Keep up the good work man!
Hey Dirk,
Thanks for kind and thoughtful commentary/feedback. Good point about shared musicality…that seems to be one of our (music therapists’) unique means of cultivating and manifesting relationship. Music-clinical relationship is, for me, certainly a special qualification of the MT. I also hear your point about breadth and depth. Yes, breadth seems more obvious, since there are so many different facets and dimensions to our field–by traversing the field “laterally” (I suppose one might call it), one can acquire a better orientation to its breadth. On the other hand, by delving into a particular aspect of the field, intensively, and in a sustained, “immersive” way, one acquires greater depth in that aspect. Interestingly, that does not necessarily mean one “overspecializes” in that area. There is a Zen proverb that, by understanding just one thing with one’s whole body and mind, one understands the entire universe…in other words, depth is not simply about mastering the concrete, technical particulars of a given practice, but rather about grasping it so profoundly, that one understands how its principle is meaningful and applicable, across varying contexts of particulars.
For example, I did my my internship back in the 1990’s at Taconic DDSO (in Eastern New York State). The clinical context there was a large, institutional community of adults with Developmental Disabilities. There, I was faced with circumstances in which clients were so profoundly disabled that there was no way that the music was going to have anything to do with their “progress,” nor was it even obvious to see how it was some sort of “diversion” in any superficial “life quality” sense. In fact, there was no authentic way even to evaluate the efficacy of my work based upon the responses those clients would exhibit. So, what was my purpose there, and how was I even to know that I was doing anything of value? The deep crisis inherent in that question was the very catalyst that made my internship into a self-transformational experience for me. By remaining still in that “problem space”–in the very disquieting throes of that struggle–as “holding myself to the fire”–I realized that my “intervention” there wasn’t about changing these clients–it was about being with them in a way that no one else would–a way of being that would provide them with an opportunity (their own opportunity–something they rarely, if never had about anything!) to be with others in a far more humanized, dignified way, in and through the music. This moment was not about adding any breadth, but about remaining as still as possible in a very specific place. Thus, for me, I did not regard that experience as one in which I was learning about how to use music therapeutic for adults with Developmental Disabilities–for me, it was about deepening my consciousness, my very capacity for being musically with ANY person in a clinical context. That doesn’t mean that I was instantly an expert about the details and facts across the full breadth of our field–quite the opposite, it instantly conveyed to me just how much I didn’t know! What it did do was to help me transcend a way of understanding music therapy as an aggregate of concrete, technical, procedural, particulars–and it spoke directly to the core of what it meant to be a music therapist, engendering a far more anchored, grounded sense of who I was, professionally, than I had formerly dreamed possible.
I don’t know if this has anything to do with being in academia vs. the clinic, for me. But I do know that, to the extent that I identify myself as a music therapist, I identify myself as one who is able to be with others musically in the service of promoting health. I also do identify with being an academic–for me, it’s an extension of a love for my discipline, for knowledge, for human beings, and for music. I am grateful for the opportunity to do, and to be, both, and for what still lies ahead for me in continuing work with clients, students, and colleagues.
Thanks again, Dirk.
Brian – thought provoking to say the least, as we use our traditional language skills in this “new” medium for discussion.
Quite a number of years ago, I prepared a presentation on empathy for a regional MT conference and I never felt like I made the musical connection. If we understand empathy as our capacity to “enter into another person’s experience” (World English Dictionary, dictionary.com) I think the empathic experience may also be, in part, a musical thought/feeling and relationship.
In my once a week MT session with the inpatients on the MH unit today (where I typically will have just that one encounter with the patient), the musical connections established in these sessions (primarily through percussion improvisation) to me are the foundations of the relationships we establish. I would suggest that the moments when all are “speaking” (using their own voice) and simultaneously “listening” are the musical thoughts that frame the entire experience and provide all present with the connections that are evoked and support our engagement in empathetic ways. And it is from this foundational music making that the processes, goals/objectives, and even all of our other paradigms can then be examined. I would then posit that by “thinking musically”, being in the musical moment, or however we describe it, the relationship between sound and no sound we are “entering into another person’s experience” and they are entering into ours.
Just my two cents worth
John F.,
Beautifully put, and clearly a direct reflection of the integrity of your clinical work. That’s a wonderful integration of the often elusive construct of empathy with the very real, physically embodied, shared/negotiated presence inherent in clinical group improvisation. It is really not hard to see, from your example, how both the clinical processes and the clinical goals can be understood (and articulated) musically…and in a most legitimate way!
It also sounds that, perhaps, you’ve spoken to Dirk’s comment (above) regarding a basis for closer examination of music and empathy.
Thanks for your thoughtful comments and feedback,
Brian
This was a wonderful article and equally wonderful comments. I realized a change in my own work unpon reading your article. Out of frustration, anger and hurt in trying to have a voice with a particular education staff,(Music Therapy is not allowed to be brought up, mentioned or acknowledged in IEP’s or with staff from other facilities, receiving our kids next.) I have almost given up with them. (I am certainly not recommending this method with staff.) However, I’m not having to worry about legitimization of goals to education standards (now neglecting quoting standards being used, worked on etc) My written goals are being written in more musical terms. I find it is not only easier to write but to work, and have always spoken this way with the behavioral staff and parents (of my clients), from whom I receive a lot of support. I totally agree with you , it is in the way you think and see things. I think this way of seeing things with your clients is so much more comprehensive. It is in this way of thinking during sessions that allow me to meet with my client and see them beyond the disability. This is what I love so much in doing Music Therapy.! Your article put this eloquently!
Antoinette,
Not only am I deeply appreciative of your feedback on what I have shared here, but I am also genuinely inspired by your particular way of coping in a very challenging situation. Instead of allowing the limitations of your circumstances prevent you from being who you are, you have negotiated ways in which you are still able to manifest your uniquely valuable set of knowledge, skills, and sensibilities as a music therapist. That is no small thing. I am so glad that what I have written resonates with some of your core professional values, and with what you already experience on a daily basis–that is truly affirming and encouraging to me. Please keep up the good work, and be strong, knowing that you are not isolated, and that others believe in the same things that matter to you.
Best Wishes,
Brian
Very well said, Dr. Abrams. Saw this come across on Twitter and have taken a few looks at it, as I left it on my desktop. Plenty to continue considering as our profession evolves.
Agreed, Andrew. I hope we can have this sort of discussion, involving many different stakeholders from many different contexts. Thanks for the kind feedback and support.
Brian I just came across Colin Lee’s book on Amazon. I haven’t read it, but may order it. I was wondering how close you would say your ideas are to each other? I’m also wondering if CMT is used mainly in stand alone music therapy centers or if it is ever used in a special education / IEP setting. I think I’m in agreement with you about some of our branches of MT coming from good research and effective, but being better viewed as tools rather than something which attempts to define us. Guess I’m somewhat an ecclectic type. The speaking/thinking musically works better with some students than others. I’m not exactly sure why yet. It might be good to have an assessment to kind of figure which students are better fits in this way of practing our work, but maybe this is going at it backwards and it’d be better to tweak the interventions rather than the case load. Or maybe being more ecclectic calls for a number of different assessments even within one population type.
Dirk, I would definitely order the book! I assume you are referring to the music-centered thinking based upon Creative Music Therapy (Nordoff-Robbins)? I would say it’s very closely aligned with the perspective I am sharing here. I know that, in Dr. Lee’s work (and in the work of many other NRMTs and MTs who work in related ways), musical process is the primary guiding factor in understanding therapy and its outcomes. Perhaps where I am going in a slightly different direction is in the assertion that thinking musically is not something limited to any particular model, nor even to music in the sense of musical sound (i.e., that music therapists are still being music therapists, and are being uniquely musical and clinical, even when they facilitate an entire session of talking). My core point is to challenge the popular conceptualization (and pervasive media representation) of what MTs do as “using” music or as targeting “non musical goals.” And again, I’m not advocating a change in language only–it’s about shifting paradigm and orientation. But I think what you’re exploring with respect to students is very important, and I would love to hear whatever you happen to discover!
Hi Dr. Brian
I read all the comments and it is amazing.I want to learn from everyone, providing music therapy.
Regards
Lata Swarn
That is wonderful, Lata. Thank you so much for your comment–I appreciate your openness to learning from different perspectives. Best wishes. BA
Hi Brian,
Thanks for this. I like the term ‘iconicity’, and would love to know more about your interpretation of it.
Musically Yours,
Pete Galub, MA, MT-BC