Advocacy

We are…not on the same page…

In honor of Social Media Advocacy Month (I never even knew that was a “thing” until now!), there’s a guest post from Judy Simpson, AMTA’s Director of Public Relations, circling the various music therapy interwebs. It is a well-written and thoroughly welcomed message. One part in particular stood out to me:

“For far too long we have tried to fit music therapy into a pre-existing description of professions that address similar treatment needs.  What we need to do is provide a clear, distinct, and very specific narrative of music therapy so that all stakeholders and decision-makers ‘get it.'”

I could not agree more. There is absolutely a great need to construct a powerful and compelling narrative that will successfully convince healthcare professionals of our independent and unique contributions, but have we even come to a consensus as to what that narrative is? I’m concerned that we’re far away from a shared message and tone that will effectively establish our field as valid, primary, and integral.

I vividly remember the first time, on some long ago listserv exchange, that I first encountered this idea that music therapy must escape the shadow of the closely related fields we were yearning to be accepted by. At the time I was a new professional, and the notion that we did not require the external validation of other professionals was jarring. It challenged a good number of the pre-existing narratives about music therapy and music therapists I had been carrying around, narratives shared among various collegial circles from student members all the way up to professional leadership. These narratives have continued to ripple, formally and informally, throughout our field, and I feel they present one of our most acute challenges.

These internal discourses are reflections of how we understand both music and music therapy, and they are so stark that they go beyond “agreeing to disagree”. These epistemological conflicts are sharply dividing the American music therapy community and hindering our ability to develop a cohesive narrative that (1) communicates an understanding of music as meaning-based and grounded in the humanities, (2) conceptualizes music therapy as contextual, relational, and interactional, and (3) establishes music therapy as a core, integral practice working in a domain of wellness that no other field does.

Here are four of the discourses that I have found to be particularly damaging to our prospects of being recognized as equals in the healthcare ecosystem:

“Music therapy is the use of music to meet non-musical goals”

Open admission: this one, above all others, drives me crazy. I have literally never heard of any healthcare profession actively denying their patients the domain of health that their entire craft is predicated upon. Do physical therapists meet non-physical goals? Do nurses meet non-nursing goals? Do physicians meet non-pharmacological goals? At what point did we become so disempowered as a profession that we felt the need to decontextualize human wellness from musicality and creativity in order to “prove” ourselves to other professionals, when really we should have been emphasizing our expertise in wellness as musicality and creativity? This goes back to Judy Simpson’s earlier point that we need to be who we are, not who we think somebody may want us to be. I am thankful to the latter day and present day pioneers who have continued to advocate clinically and philosophically for an understanding of humanity as musical. Until we can gather around the idea that to be musical is to be well, I’m concerned that any narrative we offer to other professionals will still suffer from an implicit, if not explicit, need for their validation.

“Music is best understood to the extent that we understand our neurobiological responses to it, and music therapy practice should be founded upon this biomedical construct”

For me, this is a decontextualist approach. What I mean by that is it relocates music from the humanities to the sciences, and distorts music as a meaning-based practice and experience into sound that creates linear cause-and-effect relationships. What is music if not sound that we assign meaning to? There are those who go one step further (which Meghan alluded to in her introductory post) in understanding music as a wholly unique form of human expression that can, and does, manifest as soundless. To be sure, this firmly entrenches music therapy into a grayer construct of intersubjectivity and therapeutic process, but this is where we reside as music therapists.

There’s a reason, for instance, that Neurologic Music Therapy is a training available to non-board certified music therapists: it is a collection of prescriptive techniques and protocols that do not require the musicianship, clinical intuition, and empathic attunement that board certified clinicians possess. It enables the user to wield sound like a tool in order to meet a predetermined outcome.

Music, however, is not so linear, and calling such practices “music therapy” is highly problematic. Music is an organic external manifestation of human expression and consciousness that is co-constructed by the music therapist and all the elements of the surrounding environment.  Yes, we can see how music in the moment of meaning-making manifests objectively on a neurobiological level, and that certainly needs to be taken into account in order for ours to be a holistic and progressive practice, but we cannot allow it to be THE foundation or guiding theory informing future practice. If we do so, we’re empowering non-music therapists to claim they can do what we can do (and if we build future practice around these ideas, then they would be right!) while disempowering actual music therapists from developing deeper understandings about the nuance of our craft in the service of fostering greater wellness in our patients.

“Music is noninvasive and nonthreatening”

Whenever I hear this, I ask “To whom?” I don’t even know what “noninvasive and nonthreatening” means. Does that mean music is the equivalent of a massage on the beach in Tahiti? Doesn’t that overlook the fact that we use music at all stages in life, including difficult times such as loss and hardship?

One of the most popular and stirring albums in the past decade (Adele’s 21) was about a breakup – did that not “invade” our emotional centers and “threaten” the idealizations we hold onto in order to avoid actively engaging with such loss? Is that not why, to at least some extent, tens of millions of copies of the album was sold? If Adele was singing about the perfect marriage, I highly doubt the interest would have been there because it would not have resonated so deeply within us.

At the end of the day, I think this turn of phrase is more about us than it is about the music. I think it’s a reflection of our hesitance to engage with that depth of humanity in such an intimate way. I think it speaks to concerns about talking to other professionals about the nature of our work because so few people wish to actively discuss the dangers of musicking when addressing issues such as chronic depression, complicated grief, and trauma. It calls into question our own uses of music, and by extension our own humanity, too sharply.

“Music therapy is a complementary and alternative service”

This discourse is my white whale, the one I wish to dismantle before it rings in a death knell for music therapy in EOL care. This line of thinking always makes me wonder “What are we complementing? Who are we an alternative to? Are we some kind of backup plan for when the ‘real’ professionals aren’t making the progress with a patient that they desire? Are we some kind of wildcard to throw into a clinical situation just to see what happens?”

I once heard the medical director of a branch of a corporate hospice that hires music therapists in multiple sites characterize music therapy as “the icing on the cake”, and I watched several present music therapists nod their heads in agreement. In condescending medical terminology, that means we’re there to make nice and do “happy” after the “real” professionals – y’know, the cake – get the “real” work done. And a part of me cynically wonders why he would think anything else. It’s not like there’s been an active push by our professional organization to resist this categorization among the likes of aromatherapy and pet therapy.

If we’re going to get the foothold in the healthcare community that we are working towards, we need to assign ourselves as PRIMARY care providers that work within a domain of wellness (music) in a way that nobody else does. That’s only going to happen when we stop predicating practice and justifying service on the goals and objectives of other fields, and similarly stop grounding that practice in theory centered in fields other than music.

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35 thoughts on “We are…not on the same page…”

  1. Noah, your post resonates very strongly with me, and I completely agree about the damage that is caused by all four of the narratives you described.

    Marketing music therapy while staying true to a music-centered philosophy and seeing music as a core domain of wellness has been enormously challenging. One problem I see is music therapists labeling everything they do as “music therapy,” even when it’s missing key aspects of a therapeutic process or relationship. Certainly a first step is getting our professional community on the same page about the value of what we offer, both as music therapists and as providers of music therapy (which is only one thing we can do with the education and skills that we have.)

    1. “One problem I see is music therapists labeling everything they do as “music therapy,” even when it’s missing key aspects of a therapeutic process or relationship.”

      That’s a great point, Rachelle. In some cases this is organizationally driven because music therapists are often asked to step outside their scope and music therapists have to call it “music therapy” in order to justify their employment, but at the same time there is an easy willingness – inside and outside the field – to use “music therapy” as a catch-all phrase.

  2. Hi Noah, if I may, I would like to offer an alternative to your statement that Neurologic music therapy is “a collection of prescriptive techniques…that does not require musicianship, clinical intuition” etc… As a graduate of an NMT-based music therapy program, I did receive extensive training in learning NMT techniques, but more so, I learned the approach/methodology that is NMT. Just as improvisational, humanistic, psychodynamic approaches are just that, approaches, my experience was that NMT is one approach in a diverse field. I am appreciative of the various approaches and seek to incorporate the best approach for my client(s)’ needs. That often takes forms in certain interventions, many of which are more psychological in nature, and others which are Neurologic in nature. In my hospice work, for example, there are times when a patient expresses and demonstrates physical needs that are best met with a Neurologic perspective. Still, there are times with these same patients that a psychological approach is better. I do not feel my training as an NMT student became prescriptive, however, I am aware of the reputation NMT has gained, to some extent, because there are students/teachers who align themselves with this approach quite rigidly. My experience, though, was that I had open-minded professors and supervisors, who, although trained with an Neurologic perspective always pushed me to incorporate the best approach for my clients’ needs (based on how the client/group presented and based on what research/evidence suggested for a client’s diagnosis or needs).
    Further, in relation to musicianship and clinical intuition, as a student at an NMT school, I had several years of experience as a soloist/ensemble member to develop my musical skills. I was required to take group piano, guitar, & voice classes. I was encouraged to foster my own musical growth outside of school, and I did so by singing in a community chorale and accompanying ensembles. I took counseling and psychology courses, and my MT methods courses always incorporated counseling, clinical, and therapeutic skills. My practicum and internship experiences furthered my opportunities to develop as a compassionate clinician and gain experience in letting music facilitate the client’s needs in a natural, unprescribed way.
    Those are my two cents. I am thankful to interact with people from all approaches and experiences related to music therapy, as I find it to be an opportunity for positive growth. I knew nothing about NMT before beginning my program, and am thankful for my experience at a school that happened to be NMT based. On a larger scale, I am thankful for music therapy and the diversity in approaches.

    1. Hi Katie – thank you for offering those thoughts. I agree that the neurologic perspective deserves our attention and respect in order for ours to be an integrative and balanced field. My concern is when the neurologic perspective is propped up as the primary perspective, the one through which we will gain the respect of others (by using their theories and syntax) and best develop our practice (by meeting non-musical goals). At national conference last November I presented on how a neurologic understanding of phantom limb pain could help inform a music-centered approach to end-of-life work with musicians. I’d be happy to talk to you more about this if there’s interest!

  3. I always describe what I do in my hospice work as “using music to achieve non-musical goals” because that is how it is presented in my coporation’s marketing materials — I’ve never been really satisfied with it but it DOES tend to give a shorthand block to the assumption that we, like the visiting therapy dogs, are simply there to blow sunshine up the patient’;s skirts, which seems to be what our marketers and often our patient families and facility partners desperately want MT to be. It’s discouraging. So I’m on board for finding a better set of descriptors for what a hospice music therapist does. Right now, though, all I can think of is how fun the production of “Cabaret” I just saw was and I need some tea and bed. You’ve got me thinking though. Ugh. HATE thinking!! 😉

    Carolyn Bowes MT-BC

    1. Hi Carolyn – thank you for these very pragmatic thoughts. What you’re speaking to is how difficult it is to rewire a culture that has been programmed by these damaging discourses. That’s almost an entirely different topic, but one that needs to start with changing the discourses first.

    2. I actually don’t have a problem with describing music therapy as “using music to achieve non-music goals.” I admit, I am not an MT-BC yet, I’m still working on my MT degree. But I believe this statement actually addresses one of the most prevalent myths and misconceptions about the field. Music therapy is so often confused with music education, and many people think that the goal of MT is to teach someone music. This certainly can be part of the therapeutic process, and a MT session could LOOK like a music lesson, but there is also an ultimate clinical and therapeutic goal that has nothing to do with music. Take the example of a MT using music to rewire the brain of a stroke victim so that they can regain their speech.The ultimate end goal and reason for the therapy in this case is for that individual to be able to talk again. That goal is not in and of itself musical, but that doesn’t mean that music wasn’t crucial in the realization of that goal. I really don’t see how this undermines our field in any way. Music Therapy is clinical therapy first and foremost. In that way, we are similar to other therapists. We are all clinical professionals, and MT is one of the many different kinds of therapies. The difference lies in the tools and methods used in the therapy. Our tool is music. So of course we need to be proficient musicians as well as clinical therapists. Music therapists use music to achieve therapeutic goals. In contrast, there is no therapeutic goal in music education, and music teachers are not therapists. There’s a goal, and that goal is always musical, as the job of a music teacher is in fact to teach music. But that’s not really what a music therapist does, so I think it’s an important distinction.

  4. I wish this article was required reading for new music therapists. What a fantastic discussion! Thank you or your thoughts! As a new music therapist I am encountering the very issues this article is talking about. I never realized it until now as I go out into the world and expect music therapy to be as respected as other therapies. Needless to say, it challenging not to get defensive and use these fallback quotes when healthcare professionals say things like “icing on the cake.” Our professional is evolving. We have to find a way to respect the foundation that many of the quotes were built on, while creating a a paradigm shift on how healthcare views and respects music therapy. Bravo!

    1. Hi Kelly – “Paradigm shift” is right on! And as you’re noting here, one of the most important considerations to take into account is stripping away these unconstructive, and possibly destructive, ideas from new professionals so they are freed from their limitations and free to develop an empowered, music-centered practice.

  5. Noah, I would love to hear more about your work with phantom limb pain and how using a Neurologic understanding helped. Perhaps this is an impetus for another blog post?!
    I failed to mention that I appreciated your perspectives on why we need to re-define our own working definitions as a profession. Many people have asked me, “What do you mean by non-musical goals” or even “what are functional goals”? I’ve stopped using those terms in my “elevator speech” and now, I’m encouraged to think about better, more descriptive ways to talk about music therapy amongst other professionals.
    One last thought–can non music therapists actually become certified as a “Neurologic music therapist”? The NMT institute in Fort Collins offers board-certified music therapists the opportunity to take on the name “Neurologic Music Therapist”, and extends the training to other professions, but I’m not sure that the same permission is granted to non-music therapists to call themselves a NMT.

    1. No, only MTs can call themselves NMT. All other professionals,including MT students,are not allowed to put that tytle.

  6. I appreciate your thoughts, Noah. I think for so long there’s been a push for the use of the Transformational Design Model, to achieve just what you’ve been describing–helping us as music therapists fit what we do into other domains. I’m not opposed to the TDM, but I feel that there is a time and place for it, and it’s not always appropriate for long term care and end of life care. I have two questions for you, though: 1) I don’t disagree with you, but it makes me slightly nervous to dissociate ourselves from such goal-directed work because it seems that it’s been one of our primary arguments to distinguish ourselves from others who provide music services but are not music therapists. One argument is that our training/education sets us apart. However, we all come from such different educational backgrounds and philosophical orientations that the argument that music therapists have different education from other music practitioners perhaps begins to break down as well. Do all music therapists learn to provide solid counseling skills? I hope so, but I don’t know so without a doubt. How can I argue that music therapists truly receive training that sets us apart as therapists, making us different from a music practitioner? If being musical is to be well (disregarding goals and objectives), how do we convince others that we MT-BCs are the best ones to provide this? 2) I’d love to learn about your documentation style. Hope I’ve expressed my thoughts clearly here…

  7. Brilliantly articulated, Noah. So spot-on in many ways. A very important challenge to the music therapy field, at a time when articulating the nature and value of our work has become increasingly important, as part of ensuring that we can continue to serve the public on a scale that reflects that public’s need and demand. I would like to offer responses, expanding a bit upon each of your four points of criticism, if I may:

    1. Yes, the (false) dichotomization between musical and non-musical has been highly problematic for our field of music therapy. To be musical is indeed to be well, but when we make this assertion as music therapists, we are not, per se, referring to conventionally-defined conservatory musicianship (we know that some of the world’s most talented musicians can still have lots of “issues” which may well be addressed within music therapy!). We are (or at least could be) referring to the musical dimensions of the very health domains that many call “non-musical”…just as there are physical dimensions to the production of speech, or psychological dimensions to motor-planning, there are musical dimensions to all of the above. These domains are integrated into one another, and the “specialists” of a given domain can understand their focus in the context of how it is inter-woven into all of the others.

    2. I have long held that music therapy cannot be reduced to the use of context-free sound as a physical stimulus for statistically predicable outcomes (as would be the case for a natural/physical health science), and have attempted to develop a working definition of music as temporal-aesthetic ways of being-in-relationship. And yes, the soundless dimensions of music comprise a perfect counter-argument (e.g., the music of John Cage). I believe a better developed humanities-based understanding of music is sorely needed within our field, in a way that distinguishes MT, yet does not alienate it (or others) within the larger health care community.

    3. Non-invasive and non-threatening: For a well-informed response to the ridiculous assertion to the “non-invasiveness” of music, I suggest referring to an outstanding article by Dr. Susan Gardstrom, in the Nordic Journal of Music Therapy, 2008, Volume 17, Issue 2. I will add here, however, that helping of any kind means risk. To imply that music therapy is somehow privileged because it can allow us to help, risk-free, is simply ridiculous.

    4. Complementary/Alternative: Yes, this way of framing our work is definitely problematic. Historically, the terminology “complementary/alternative” has denoted forms of treatment with goals common to those of medicine, but which achieve those goals through non-conventional means (i.e., homeopathic medicine, vs. allopathic medicine). The funny thing about that is once such an unconventional intervention undergoes testing and research with sufficient rigor, there really is no longer a distinction between “regular medical” and “alternative to medical”! In essence, the latter has simply been defined as having not yet been subjected to the same scientific scrutiny (which, I believe, is also why these interventions have cultivated such suspicion in their general perception). Music therapy does not fall into a category of a unscrutinized intervention with goals common to those of medicine. Perhaps the complementary dimension are the GOALS themselves, in that they complement what medicine achieves, in the larger, overall scheme of a person’s wellbeing…but that, as I understand it, is something different, and is part of moving toward defining what we do by a unique contribution to a client’s life, not simply taking a different route to the same thing.

    Thanks again, Noah, for this great piece…and Happy Social Media Advocacy Month…remember to celebrate responsibly, everyone!

    Brian

  8. Noah, thank you for the post, though I admit I’m not on FB so received this through the MT Listserv. As always I applaud your passion and thoughtfulness and would like to comment and give some potential food for thought. We are not the first, nor only, profession to have difficulty coming to a consensus in regards to the description of said profession. And if the stories told to scare young music therapists late at night are to be believed, this has been the case since the beginning of time, or at least the 50’s. And yet our field has continued to grow and persevere, albeit slowly and with many aches and pains. But I do find your post to be rather provocative and somewhat in line with what you are arguing against. I do not believe there is one “right” answer. This has been the sticking point for years, each “camp” believes their answer is THE answer as opposed to considering that everyone at the table might actually be right. What resonates with one might be discordant to another. I chose Colorado State because what was being taught there “worked” in my way of thinking and envisioning how I could use music to help others. I knew fellow students who transferred elsewhere because it was not their cup of tea. Was one of us right or wrong? The travesty to me is that not all young music therapists get the opportunity in their education to be exposed to all the different approaches of music therapy, and I don’t mean reading a chapter on each during Intro to MT. Only when that point is reached will our field have the ability to provide proper discourse as to what MT is.

    I believe Brian is correct in his way of thinking, at least from a music therapist’s perspective. However, in the rehab arena that I work, many of my client’s find music to be intimidating and the idea of approaching many of these clients with the idea of addressing their musical well-being would likely lighten my case load quite a bit. This doesn’t mean that I’m not potentially addressing several different areas of their musical being. However, that is secondary to staying focused on what their need is, as expressed by them. There have been conferences I’ve attended that have had sessions entitled “it’s about the music, stupid”. And there have been many listserv arguments around this very foundation. For me this has been one of the craziest things I’ve ever heard. It’s about our clients and how we can utilize our knowledge and skills to meet THEIR goals and objectives, which may be the same as if they were being treated by an SLP, PT, OT, etc. The notion that any music therapist isn’t thinking about how to utilize their musical skills and knowledge therapeutically is insulting. The fact that this can be done through a variety of models is actually exciting and shows how the field of music therapy can continue to grow through its diversity.

    I’m a brain guy, probably early signs of Zombie-ism. For me, understanding how the brain processes music in different ways does it for me. I also recognize that there are many ways of approaching, understanding and feeling music. Seeing music and music therapy through a neurobiological prism or using music to meet non-musical goals in no way emasculates myself as a musician or music therapist, nor do I feel that by doing so I am detracting from the field. From what my clients say it’s a good thing as many of the people I see have been unable to find consistent help with their individual rehabilitation needs. Again, it comes down to the approach that, in my opinion, makes me a good music therapist. That doesn’t guarantee that this approach will make someone else a good music therapist or that another approach won’t make another person a good music therapist.

    Thanks for the forum.

  9. I appreciate Dwyer’s thoughts. And I sincerely hope that we do value “our perspective” as music therapists. Strangely, we don’t seem to give that perspective nearly as much attention as our concern about whom it could frighten away. I, myself, find something odd about shying away from the very core of our work, because we are concerned that our clients will find it intimidating. I think it may be an assumption that there is only one way of presenting a music-centered perspective in music therapy, and that it will deter clients from working with us. I can tell you that from my own experience, which includes some work in physical rehab, I have never encountered this, and have never felt the need to downplay the centrality of music in my work. Nor do I believe for a moment that I am any less client-centered by remaining true to the centrality of the music in the work, including in goal areas that are absolutely about their (the clients’) needs, even if this means educating and advocating about ideas that may be new to some. I find the dichotomy between it being either “about the music” or “about our clients” troubling. To me, part of the value in what Noah is presenting here is that it is a call for new and creative ways of marketing what we do effectively, yet in ways that remain true to “our perspective.” I don’t hear this being about music therapists not utilizing their musical skills, nor about rejecting a diversity of approaches–rather, I hear it as challenging certain ways in which we may, in the interest of marketing, be alienating ourselves from much of what gives us our uniqueness as clinicians. If this happens not to be a given MT’s personal experience, that is certainly valid. My understanding of this conversation is that it addresses a more general, field-wide patterns of discourses that a number of us find troubling, and I’m therefore glad we can have the discussions about them, such as these.

  10. Also, for further clarification: According to the NMT website (http://www.colostate.edu/depts/cbrm/institute.htm), the training “is open to students and professionals outside of the field of music therapy” and that there are “no required prerequisites to take this training…Completion of the training in its entirety is expected to gain the NMT credential and certificate.” The caveat offered is “Completion of the NMT training does NOT allow one to practice outside their professional licensure-training certification.”

    1. Thanks for that Brian. I was remembering the daily reminders of that fact during the institute and generalized that fact incorrectly.

  11. No worries, Dwyer. It could simply be that the website requires an update…but that is clearly up to the institute staff/Dr. Thaut.

    1. Also, thanks for the thoughts. I wanted to clarify that my comments regarding the idea of not focusing on the music being insulting were specifically related to the “it’s the music, stupid” sessions.

      I agree that the primary impetus to Noah’s thread seems to be in regards to the general marketing of Music Therapy. However, the notion of getting these “unconstructive, and possibly destructive, ideas” away from young music therapists takes that a little further. We should be helping our students, and as such our professionals, gain a better, non-judgemental, understanding of all the differing approaches in our field. This will also give our young music therapists a better ability to choose where they(want to) fit and perhaps begin to shave away the polarizing discourse that has been in place since I joined the profession. While this would be great to do from a top down approach I feel that there are currently those with very entrenched ideologies that have too much invested to budge much from their current stance.

      1. Important points about encouraging diversity of thinking, Dwyer (and thank you for the additional clarifications on your position). Clearly, being non-judgmental is an important dimension of that. However, I would distinguish judgmental from critical. If we must accept, without question, everything and anything that is presented within our field, without applying our discerning wisdom and knowledge, we are not acting responsibly on behalf of the field and of the public we serve. Thus, I believe we, as a field, must be mature enough to engage in critical discourse, without leaping to a position of defensiveness or of becoming apologists for a particular approach. And, if I’m not mistaken the very issue you cite–that “there are currently those with very entrenched ideologies that have too much invested to budge much from their current stance” is precisely that to which Noah is alluding in several of his own criticisms.

      2. Agreed on all points. My experience has been mixed in regards to critical vs judgmental and that the comments of one or two people can make an entire approach anathema in some academic circles. And yes, I agree that this is what Noah has alluded to. But I feel the argument made is to move to something new that doesn’t include them rather than ignoring their desire to see theirs as the only way and embracing the idea that all of these ideologies are all parts of the same whole. Perhaps I am misreading.

  12. Brian, I believe you left out a very important line….And I quote… “Completion of the NMT training allows the board-certified music therapist to practice and use the credential of Neurologic Music Therapist (NMT) for three years. This training is open to students and professionals outside of the field of music therapy, however, completion of the NMT training does NOT allow one to practice outside their professional licensure-training certification.” (http://www.colostate.edu/depts/cbrm/institute.htm)

    So, when did it become ill-advised for professionals from other disciplines to attend conferences and trainings geared for music therapists? I have been invited and will attend a training being offered by a PT later this week. I do so to better understand therapeutic techniques and treatment protocals used by other disciplines. Once trained, does that make me a PT? No, but it does not mean that I may not adjust my approach slightly if a better outcome can be found by incorporating something I learned from another professional while working with a client from my own music-centered approach. That’s professional development. Why must we insist on drawing these lines in the sand, between us and other disciplines, and even between us and ourselves? To me, this thrashing of egos is an unecessary distraction to us and our potential clients. I have work to do and I believe I have been prepared to do this work. Our clients are counting on us. Our clients are changed by our music…by their music… by our engagement with them. Let’s let our outcomes speak for themselves.

    1. Casey, please see my comment under “caveat”…I actually included what you are stating I excluded. However, the scope of practice exclusion is standard for any training, and essentially goes without saying. It is quite different from “only MTs can call themselves NMTs” (for example, in GIM training, a non-MT can call themselves, and ARE, Fellows of AMI when the training is complete). That is not consistent with what is on the Website. I am simply stating that as an observation. Again, perhaps the website is due for an update.

      Who here is claiming that it is “ill-advised for professionals from other disciplines to attend conferences and trainings geared for music therapists?” I guess I missed the whole sand-line-drawing and ego-thrashing part. Can you clarify about the sources of your concerns on that?

      I believe Noah’s critiques are, quite purposively, speaking on behalf of optimizing quality of services for our clients. How else but to critically reflect upon the current state of our profession, so that we may grow, can we ensure that? I would be more concerned about the opposite: Avoiding critique and continuing to walk on eggshells around one another, because of the fear that it might ruffle feathers. I would hope that we are mature enough to engage in dialogue that helps one another grow beyond our current stage(s) of development (I, for one, appreciate that from my colleagues).

    2. But to get back to the question I asked Dwyer–can you define how your use of the NMT techniques as is different from a PT using NMT techniques? I think this is some of what Noah is trying to help us a profession tease out–what belongs within the profession of music therapy? As Brian stated, I am not seeing any lines drawn in the sand. What I am trying to do is participate in a dialogue that challenges us to think about what we do at a deeper level; beyond stimulus and response.

      1. If the point of this is truly to tease out “what belongs within the profession of music therapy” then it will be a long process that will likely culminate in a very similar scope of practice that we currently have and with much the same disagreements that currently exist. Since some could argue that everything we do in life is about stimulus and response that does seem to be a good place to start any therapeutic practice.

        To answer your question specifically. As I have had the privilege of working with a PT that helped develop some of the NMT techniques I can tell you that she adds more rhythmic emphasis to a lot of her work and is quite cognizant of entrainment principles but she isn’t about to pick up an Autoharp and begin trying to play during walking or working on specific movements with her clients. However, having both a PT and MT who have both taken some level of NMT training usually results in both having a better discourse in how to treat common patients. Neurologically, understanding the importance of rhythm to the brain can be key in explaining why the use of an MT is warranted. Being cognizant of entrainment principles and how they can positively effect your outcomes adds to your relevance. If you’re looking for something to say “well, you don’t need a PT but an MT”, in the populations I work with that’s not going to happen. However, my clients often perform better in their other therapy sessions and I also have an obnoxious tendency to show positive results for my clients who have been discharged from other therapists for not continuing to show progress. I think part of what Noah has alluded to is making the overall discussion about having a PT and an MT where the MT isn’t brought in as a frill with no understanding of what they are doing. I do not look for approval from the other professions, as a matter of fact I am often quite direct in discussing things with other professionals that have been successful for me that they might consider.

        Much of what I do is based on stimulus and response but all that I do is centered around music and how I can use music to reach my client’s goals. However, without an understanding of how we respond to music and why, it’ll be difficult to proceed at any level or with any population. Hope this helped.

  13. Hi Dwyer,
    I am appreciating your contributions as always but I admit to feeling troubled by this sentence: “Since some could argue that everything we do in life is about stimulus and response that does seem to be a good place to start any therapeutic practice.”
    I have to ask… What about dreams? What about relationships? And, what about music? I just can’t see the application of this very concrete and rigid concept to so many aspects of human experience, aspects of the human experience that are deeply inhabited in our art form of music. I get that NMT might be all about stimulus and response, but I can tell you that I have never known a person whose life or behavior could be reduced to that. When we are talking about it that way, we aren’t only reducing the music as Noah talks about in this post… We are also talking about reducing our patients. Even neurobiologically, we know there is so much more to humans than stimulus and response.

    1. Thanks Meghan. It is often hard to distinguish a smartass from a reductionist:-) Of course it is not just stimulus and response. However, we also can’t forget that much stems from that and that there is a time and place for it. And NMT, while quite a bit based in this, is not all about this. When I work with a stroke client who can’t string two words together, of course their is relationship building between the two of us. I work quite extensively, non-musically, to help that person’s family get better insight into what they are going through and how to, hopefully, engender a more healthy atmosphere when there is so much frustration and non-communication. The music I use is designed specifically to elicit improved speech, based on what I know neurologically and how the brain processes music. If it were as easy as singing familiar songs there would have been a cure for aphasia centuries ago. So the “music” is in the shape of melodic phrases and exercises that achieve the desired results. I use all of my musical knowledge, including neurological, to get these results. All of it steeped in music but most of it geared in stimulus and response. I guarantee you none of my clients feel I am reducing their lives.

      However, as I have stated earlier, this is one approach that has its prudent applications. As there are many approaches in Music Therapy that have prudent applications.

      1. I think there is a difference between being understood as a person who sees clients and music reductionistically, and the question about whether we may be mixing levels of part and whole in our work, such that we are “using” something irreducibly whole that exists inextricably from its social context (i.e., an art) in a way analogous to the administration of a physiological medication, stimulus, or technical procedure internally inconsistent with the actual nature of music (as something beyond sound patterns alone). There is nothing wrong with physical, technical interventions that promote statistically-predictable, stimulus-response patterns in the best interest of a client, when that is the nature of the discipline (i.e., physical medicine based upon natural science)–that does not make a professional anti-humanistic; however, it is questionable as to whether this paradigm is in the nature of an arts-based discipline (in which artistic wholes cease to be what they are when reduced to their constituent parts, and in which statistically-predicable outcomes hold little relevance, when it it up to the client as to how these opportunities are utilized). This is not a judgment, but a question, based upon following a basic line of reasoning, informed by a massive research base on relational, human development and musicality–and as an extension of this question–a deeper question as to how this informs the extent to which we are actually bringing our true expertise to our clients in addressing their needs (regardless of the surface approval they may or may not afford us based upon what we currently do…I share that last bit because I know, from experience, that not everything the client tells or shows you is your best indication that you are serving her/his best interests).

      2. This is a lot to catch up with! Dwyer, thank you for helping to get this robust discourse rolling – as always, I’m appreciating your thoughts here. My point is not that NMT techniques do not have a place in a larger, holistic music therapy practice, but that I question whether a set of stimulus-and-response techniques is deserving of being called a stand alone music therapy approach. In the multiple examples you’ve been providing here, you’ve been stressing that stimulus-and-response is not the sole means by which you practice, that your practice is “filled out” by relationship building and attunement. Perhaps this is where we’ll disagree, but I do not believe an approach that is strictly neurobiological can truly preach such person-centeredness due to its epistemological foundation.

        The point of my post was not to create an argument against neurobiological techniques, but rather to question whether the neurobiological narrative should be primary if we’re to advance music therapy as a music-centered, aesthetically based practice.

      3. Ahh. Here lies the potential difficulty and gets to one of your root issues, only at the specific level of NMT. Marketing and slogans. I have seen and responded to questions regarding the NMT institute and it has been brought up correctly that the NMT institute is professional training, continuing education if you will. And while the institute is the sole vessel for receiving the NMT designation, it is a 19 hour training that provides the fundamental building blocks to an entire approach. However, the take home is usually these shiny new techniques that the participants have seen used in action and have oohed and ahhed at. NMT offers something that is difficult in other approaches…somewhat instant results. Now these aren’t necessarily long lasting, but in the moment with some of the techniques, you can see an immediate physical change, not affect or emotion or facial expression, but someone speaking a phrase they couldn’t say 2 minutes earlier, or someone walking straighter. So it gets press and lots of talk, music therapists new to this get energized to try them at home (not unlike attending conferences). Buzz phrases like generalizeable, TDM, functionality and non-musical goals get bandied about and then those MTs who have been newly minted NMTs go back to regular MT life and many end up struggling to incorporate what they saw into their regular routine.

        NMT is no more a bunch of stimulus-response techniques then NICU-MT is about a pacifier that plays music. These are often the end products that are marketed and get the most attention but only after due diligence to the foundations of music therapy, and yes, to a music-centered, aesthetically based approach. The question that no one has asked is this “is there a lack of trust/fatih in AMTA and/or CBMT?” Because the root of this, to me, lies in our educational competencies and certification. I don’t believe that NMT is being tauted (couldn’t resist) as the face of Music Therapy. However, since this discussion is occurring it would seem that there are those who feel the education provided in institutions that are heavily based in the NMT approach do not provide the appropriate measure of music therapy training to properly represent the field in their particular domain.

  14. Dwyer, my questions below are my responses to a several key statements, from your reply, above.

    “NMT offers something that is difficult in other approaches…somewhat instant results.”

    Actually, one of the things that distinguishes an approach like GIM (as a contrasting example) is that clients often make major psychotherapeutic progress within a single session. Certainly not always, of course (as is also the case, presumably, with an approach like NMT), but it CAN happen that way. Results in any authentic therapeutic process may be rapid, or may take time, depending upon the context and the scope of the targeted change. I would assume the comprehensiveness of the training dispels any tendency of trainees latching onto the “fast results” element of the model, and that it prepares newly-minted NMTs for the struggle of incorporating what they learn into their “regular” MT life and routine.

    “NMT is no more a bunch of stimulus-response techniques then NICU-MT is about a pacifier that plays music.”

    I don’t think anyone is asserting that either training is merely a “bunch of” techniques of any kind. However, as I understand it, they are both founded upon stimulus-response paradigms of change (on the material/physiological or behavioral level). Isn’t that the key to what makes them “scientifically sound” interventions with inferentially-predictable outcomes (a value basis central to these and other approaches, from what I have read about both examples you have cited, here)?

    “…but only after due diligence to the foundations of music therapy, and yes, to a music-centered, aesthetically based approach.”

    Would you kindly elaborate upon that? I am interested to understand better how “music-centered” and “aesthetic” are construed in the context of approaches wherein processes consist of employing musical sound as part of a planned set of cause-effect mechanisms. Are the goals understood musically, for example?

    “Is there a lack of trust/fatih in AMTA and/or CBMT?…it would seem that there are those who feel the education provided in institutions that are heavily based in the NMT approach do not provide the appropriate measure of music therapy training to properly represent the field in their particular domain.”

    I do think there are questions being raised about, as you say, the way they are marketed and represented to the public–that is different from questioning one’s faith in our Association and/or Certification Board. At the same time, I certainly hope we do not maintain unquestioning faith in these organizations, but continue to consider what they are doing, and why, from a critical standpoint–as well as to remain active as members/certificants, to hold our profession accountable for upholding the highest standards of quality. I suppose I see that as a responsible investment, as opposed to faithlessness or mistrust.

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