“Music preference” is a big buzz word in EOL and palliative care, dominating many recent discussions about assessment and treatment planning. There seems to be, in fact, an overall push in the larger music therapy narrative for an increased focus on emphasizing preference in most areas of clinical work. The spirit behind this push makes a lot of sense: we want to engender in our clients feelings of empowerment and self-determination that can first manifest in the clinical setting and then in real-life scenarios. Increasingly, however, I’m questioning whether preference is the right approach.
After countless assessments focused around preference, I’ve begun to ask myself “So what if he prefers Frank Sinatra? What does that tell me exactly?” The push for music preference presupposes that preference indicates a deep level of meaningful engagement with a song, artist, or genre. It assumes that there is a significant reason why that music is preferred and so it needs to be a part of future sessions.
These assumptions gloss over the relationship developed by the individual with not only with that specific artist, song or genre but with music and musicking at large. There is a significant difference between preferences for, say, Be Thou My Vision drawn from private receptive experiences listening to the song at home, public performances singing it with the church choir, and selectively shared reorchestrations explored with a worship band. The nature of engagement across these experiences indicates differences in the music’s function and role for the individual.
I became aware of this distinction between “preference” and “relationship” when I began receiving multiple requests for I’ll Be Seeing You. Taken for face value alone, it’s a song about remembering a loved one. Culturally situated, however, it embodies a wartime generation’s longing for partners distanced by oceans and bloodshed. The power of this song is evident as it resonates with forgotten or dormant emotional areas of the older adults who lived these experiences of longing.
So is that preference? I suppose it would depend on the individual. Some welcome intense emotions while others do not. For the former, a song that elicits such intensity may be preferred but for the latter, it may not be. That said, it is our job as therapists to be able and willing to challenge our patients to expand beyond the potential safety and protection of preference to develop and grow.
When working in psych, I once had a young patient who was admitted following a drug overdose. In group she frequently requested intense songs and offered invaluable insight about the meaning of the lyrics and the power of the musical features. My third session with her I decided that she had developed into a strong enough group leader, and that the group was functioning well enough, to work with Hurt by Nine Inch Nails. Handing out the song lyrics at the start, this patient became white as a sheet and visibly distressed. When I checked in with her and reminded her that she had led the group through meaningful experiences with similarly intense songs, she replied “But I don’t know this one”.
My mistake was immediately apparent. I had assumed music preference simply meant “songs I like”, but the fallacy of that assumption was now exposed. This patient’s preference was not for intense songs that would challenge her, but for previously known intense songs for which her emotional responses were so metabolized that a narrative cushion buffered her healthy Self from her addictive Self. In essence, she used music as a means of avoiding an authentic experience of confronting her undesirable behaviors and thoughts.
I believe we’ve reached a point of clinical practice and theoretical development to move beyond music preference. Speaking frankly, any trained musician with average empathic abilities can assess for music preference and provide a live music experience using those preferences. Only a music therapist, however, is trained to assess a music relationship developed from lived experiences informed by cultural, religious, and personal contexts, and to integrate that relationship into a therapeutic process that safely challenges patients to optimize their wellness.
It’s time we planted our flag in that unique therapeutic experience and claimed it as our own.