Advocacy

re: VISION

This year’s Social Media Advocacy month is focused on VISION: We Value this endeavor, we Imagine Success in our advocacy efforts, we Invest in advocacy Opportunities Now and whenever possible. For participation in this effort, we decided to engage with each other in a discussion about our vision for music therapy and end-of-life care. Please share with us any responses you might have, and what your vision for the field may be. As always, thank you for being a part of this community

Noah

Vision is an interesting choice of topic for this year, and certainly a timely one given the (seemingly endless) internal and external conflicts about vision that are so ripe in our field. As an often active participant in those discussions, while I do not tire of the discourse, I do tire of the conflict. It reminds me of my time at Temple, which prided itself on its diverse student body but did little to nurture the various sub-communities to interact and integrate. What good is diversity without meaningful engagement that facilitates widening of perspective or deepening of knowledge?

That same question can be asked of constructing vision for the future of our field. While I certainly do not agree with all of the visions that others champion, I wish there was more room for ongoing respectful disagreement that embraces the ideals of critical thinking, dynamic/evolving knowledge, and reciprocal exchanges of knowledge and philosophy. Such a process is in stark contrast to “agreeing to disagree”, which, to me, is merely a socially acceptable way of backing out of critical dialogue so as not to offend another party or challenge yourself to temporarily assume another’s perspective. It when we fail to listen with such intentionality and authenticity that turf battles begin to be waged.

So I suppose thinking on vision, I find myself not so much interested in the “what” but rather in the “how”. In other words, I’ve been exposed to a lot of different theoretical, educational, and clinical visions over the years, but the facts of those visions interest me less right now than the processes by which that vision is conceived, enacted, and received. By extension, I’m curious about the stakeholders in any given vision and the various roles that stakeholders assume, i.e. are they creating, enacting, or receiving that vision?

This has a lot of significance and implications for music therapy and end-of-life care. Music therapy is not a mandated service in Medicare’s Conditions of Participation for hospice providers, and I’m not sure when a push will be made for that to happen. In truth, I’m concerned about when that push occurs because I don’t know to what extent I trust the process. Hospice music therapy can be dominated at times by fluff and puff stories, the kind that espouse narratives designed to draw emotional responses rather than thoughtful consideration.

Not that emotional responses are wrong because certainly emotions make a story more real and lived, but it strikes me as manipulative when we make the clinical vignette more about the vignette and less about the clinical.Instead of focusing on the clinical process, which can help others expand on their practice, we begin to talk about hospice music therapy being a calling (as if people die to ensure we can work with them), which instead leads to self-congratulatory behavior. In other words, the focus shifts from client well-being to practitioner ego. That’s not the type of vision that I wish to see leave its imprint on either policy or policy makers.

Meghan

I like Noah’s point about wondering what vision of end-of-life music therapy will move into the fore if/when music therapy becomes a mandated service, or even (I would add) if it just becomes a service that is more widely recognized/understood/utilized.  I think my reservations about this are similar to his.  Why has music therapy been an organized healthcare profession for so long and yet we are so often forgotten, or worse yet, dismissed by the rest of the healthcare community?  I can’t help but suggest that perhaps we can connect this, at least in part, to the dominant, prior/current vision of what music therapy is and where it fits.  Perhaps the one dominated by what you call “fluff and puff” stories, Noah.  Of course, it’s not really about other professions taking us seriously (although I do think that’s important) — it’s about us taking ourselves seriously.

I think it would be interesting to talk about what it means to take ourselves seriously.  To me it sometimes feels like music therapy discourse denies the serious or more sobering aspects of the problems we are trying to help with, or maybe denies the real depth and darkness of them.  (And yes, I know everyone knows that I have written and presented about this before, but I suppose I don’t run out of things to say about it.)  For instance, I’ve seen a frightening number of new music therapists espousing the idea that you can treat depression by singing happy/positive/motivating songs.  That, to me, is a kind of denial, both of the patient’s experience (as if breaking out of depression were ever that easy) and of our own (and the music’s) ability to go there into the really serious places.  I think it’s the same as with the “fluff and puff” stories, where we are leaving out so many “serious” aspects of clinical dialogue, almost like we are denying that they are relevant.

I just want to add one point about the distinction between emotional responses versus thoughtful consideration in our discourse: I don’t think we want to replace the way that our stories draw emotional responses with something more thought/cognitive-oriented, but rather to keep the emotional elements and deepen them, and then use them as a pointer toward clinical insight.  For instance, maybe instead of talking exclusively about how moved we are by end-of-life work and what a calling it seems to be, we could add our feelings about how sometimes dark, sinister, and absolutely brutal the work can be.  From there, we can move into thoughts about what it means to “be with” someone in that way, clinically, and how we make choices about when and how to stay with it or cope with it or try to help the client find his/her way out of it.  I love the way that our field can draw emotional responses, but I think the clinical thoughts and consideration are held back because the full aspects of the emotional experience are also being held back.

Noah

Thank you for that clarification, Meghan, about wanting to retain the emotional value of a story but with deeper, more human shades of lived experience coloring those emotions. At times I feel those of us who wish to invite in those “dark, sinister, and absolutely brutal” elements of the work are maligned as not embracing the “fun” of the field, whereas I do not see them as mutually exclusive. Just because an experience has darker elements does not preclude it from having moments of playfulness. If anything, playfulness is all the more vivid and accentuated when contrasted with the dark, and one can appreciate the inherent beauty of each when experienced alongside one another in a natural flow of experience.

I suppose if I were to name a vision that I am hopeful for, that would be it: a balanced aesthetic. A balanced aesthetic would acknowledge, embrace, and nurture the profound beauty and meaning indigenous to all facets of the therapeutic process in music therapy.

Jill

Yes, a balanced aesthetic would help us take ourselves seriously. Clinical thoughts need to be emphasized, along with the emotional impact this work often carries. We are thinking and feeling creatures, and to value both will serve people and the profession well. Our thinking-dominated society could certainly benefit from a better balance of these two ways of knowing, too.

Noah, you made a plea for “ongoing, respectful disagreement” in contrast with “agreeing to disagree.” I think this wish would become a reality if we could stop being blind to our differences. I think it’s futile to look around at each other and pretend all we see are a bunch of music therapists. We might as well, in our racially diverse world, pretend to be colorblind. When I entered the profession, I envisioned everyone with the MT-BC credential welcoming each other underneath our shared umbrella. Now, I wonder if that umbrella is what hinders us. At the very least, trying to pretend we’re all the same gets in the way of us advancing the potential inherent in each theoretical foundation, approach, or model. Each subset of music therapists spends so much time and energy advocating for itself amongst other subsets. Yet, all the while, in our daily work we are driven by different understandings of music, different understandings of people and their needs, and different understandings of therapy. We are doing different things. There might be less conflict if we acknowledged this reality.

We can also create a more realistic vision if we acknowledge our differences. There are ways in which, by taking ourselves seriously, we can advance our own areas of clinical practice both as individuals and as subsets. Each subset needs to make every effort to do so in ways that will ultimately benefit their unique patients the most (e.g. by optimizing awareness of, and access to, their unique services), while also leaving room for other areas of practice to grow. Meanwhile, we will also discover ways in which our efforts can and should be combined for greater impact.

Before closing here, I do want to echo Noah’s question as to how we’re carrying out our vision. If all we’re doing here is talking about a vision, then let’s please admit that we’re wasting our time. Talking about this topic is only going to be meaningful if it leads to action. In every moment of dialogue we have to be asking ourselves, “So what am I willing to do about this?”

Kristen

I’d like to start my response by circling back around to challenging our comfort levels related to discourse. As a frequently misunderstood and misrepresented profession, I believe this discomfort in discordant dialogue stems from a fear of not presenting a united front to the public. If we’re all saying different things to the newspaper reporter then how is anyone outside of the profession ever going to “get it right” in their representation of music therapy practice? I think that fear is holding us back in our inter-profession growth.

I have seen a similar parallel in my small music therapy department where I work. As we cultivated our professional identity and worth to the organization, we drew many lines related to what does and does not constitute music therapy practice. We had to first make many of these concessions among our own team for fear that we would confuse the staff and thus the administration would see us for something beneath what we thought our worth to be. Looking back at that crucial time in our program’s development, we undoubtedly missed many opportunities to engage in the musical community for fear of public perception. As our acceptance grew and became more unconditional, so too did the expanse of provision of services. We became less concerned with administrative perception and more interested in being musical conduit for the community of the facility (children, families, staff, each other). This was a developmental process and one that we agreed upon together. Discourse and opportunities were sacrificed at the expense of acceptance and status. While we arrived at our destination in the end, did the ends justify the means? Could we have arrived there by any other way? Perhaps. Perhaps not.

The music therapy community appears to be fighting a war on two fronts. We are fighting for recognition, acceptance and status from the public at large. We are also fighting each other. I agree with Noah’s earlier statements. I do tire of the conflict, not the discourse. The question for me is, can we sustain a war on two fronts? Can we handle the fear of public confusion against our own obvious need for interprofessional discourse? We are obviously four clinicians who hold similar values and a vision for how those values could be manifested within end of life care. I believe that one of the core reasons for this blog is the encouragement of discourse related to our visions. My vision is for this to be a place of open, honest dialogue (to an extent greater than it’s been this past year) seeking to build on the very fibers of our therapeutic being. I think the “doing” that Jill spoke about is the continued modeling of this honesty and discourse through our posts. I challenge others to do the same.

Jill

Kristen, can you clarify what you mean by the “musical community” (i.e. “Looking back at that crucial time in our program’s development, we undoubtedly missed many opportunities to engage in the musical community for fear of public perception.”)?

In response to your comments, Kristen, it’s a striking parallel you draw between the struggle to develop legitimacy in the microcosm of your workplace and the situation in our profession at large. It sounds like one of the most significant phases of that development was an outcome of focusing intensely on the patients and their needs. Focusing on the patient is definitely one way we could all be taking ourselves seriously (harkening back to Meghan’s initial comments). Culture change can’t happen without movement at the ground level. There will never be any more effective way of changing the culture, of doing better advocacy, than serving patients well.

Kristen

Jill, I guess I really meant ways in which music manifests itself naturally without our facility’s community: playing live music during the holidays, birthday party or special performance, etc. Seen through a community perspective, these musical interactions are indigenous to the community and its health and therefore constitute music therapy practice. However, seen through a stricter lens, these events appear to be more recreational music making and “not music therapy”.

Noah

Jill, I like what you said about virtuous practice being the best advocacy, and I would add that an important part of serving patients is not only meaningful practice but meaningful framing, contextualizing, and communication of that practice with minimal reductionism of process and aesthetic.

Jill

Thanks, Kristen.  Clearly music is part of the culture there.  It makes sense that there could be apprehension around getting involved as music therapists.  It also makes sense that becoming part of that culture could be a clinically sound, natural but deliberate intervention, especially if it is carried out with (rewind back to Noah’s last comment) “meaningful framing, contextualizing, and communication of that practice with minimal reductionism of process and aesthetic.”

Noah

As we wrap up this discussion (and I hope we do this again around future topics)there are several themes that seem to have emerged:

  1. Constructing a model of professional advocacy driven by patient needs and enacted by all of us, with a seriousness about the depths of human experience.
  2. Representing ourselves with effective clinical work, along with cases and stories that include authentic emotional content as well as clinically-relevant language grounded in sound theoretical foundations.
  3. Engaging in dialogue that remains both critical and respectful in the interest of creating, enacting, and spreading this vision throughout the healthcare arena.

As always, we welcome discussion in the comments section below and we hope to hear your voice. Thank you for taking part in Social Media Advocacy month with us.

Note: As the profession of music therapy has been moving forward with recognition at the state level it has been identified that a document was needed to reflect a similar format to other health care professional organizations Scopes of Practice. CBMT and AMTA worked together to create a Scope of Music Therapy Practice (2015) for the profession based on published documents from both organizations.  This new document entitled Scope of Music Therapy Practice (2015) is available as an educational tool and legislative support document that broadly defines the range of responsibilities of a fully qualified music therapy professional with requisite education, clinical training, and board certification.

Click here to read the Scope of Music Therapy Practice (2015).

Advertisements

1 thought on “re: VISION”

  1. Wonderful, thought providing conversation founded on respect. I agree we need more conversations to move our profession away from defensiveness and help us make music therapy a basic standard of care in healthcare, similar to PT, OT, and ST. Keep sharing your thoughts!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s