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Music IN Therapy vs. Music AS Therapy: A Change in Perspective?

by Kimberly on July 25, 2014 · 3 comments

A fellow music therapist published an insightful piece this week about his journey from a music snob to a music therapist. Based on comments and article shares, his post seemed to resonate with other music therapists. It did for me, too, but not in the music snob way . . .

See, I’ve been trying for years, now, to wrap my head around the concept of the role of music in music therapy. There seem to be different ideas on the topic that fall on a continuum between “using” music as a “tool” and “being” in music. Or stated differently, the use of music IN therapy versus the use of music AS therapy (which I’ve blogged about before). There have been discussions on Facebook—which I occasionally chime in on—and in-person exchanges. It’s been blogged about and discussed among academics and clinicians.

I have commonly fallen in the gray area of the continuum feeling, based on my understanding, that there are clinical situations that warrant the “use” of music and those that warrant “being in” music. Noah’s piece made me think differently. He wrote:

Integral to that process, though I was not aware of this at the time, was distinguishing between engaging with music and playing music . . . To play music is to “do” music. It is the claiming of ownership over an artistic process and the subsequent artistic product. . . Engaging with music is a form of “being” in and with music. There is no ownership over process or product . . .

Many of my colleagues will disagree with this statement, but playing music, even when our role is to perform, is not a feature or function of music therapy. Anybody can play music at somebody because it requires minimal nuance . . . Engagement with music, however, is the skill we struggle with for all those years in class, practicum, and internship . . . What I am an expert in is structuring individualized music experiences with others that facilitates a wellness meeting their needs, not my own.

Something clicked for me when I read his words. I DO agree with you Noah—the way you have it defined, playing music is not a function of music therapy.

I have seen this in music therapy students time and time again. There is a shift that happens in the last semesters of a student’s music therapy education. It is a shift from focusing on one’s own music making to focusing on the client. It’s moving beyond the “performance” aspect of music (centered on the self) to the clinical aspect (centered on the client).

Moreover I’ve seen it in myself, in my tendency to deflect requests to play guitar or sing in public. The perfectionist musician in me is still very much alive and I am not yet at a place where I feel comfortable “performing” for others unless I am practiced and prepared (though, admittedly, that’s a fear I hope to overcome one day). But put me in a room with clients? There is no perfection. The anxiety dissipates. It’s not about me.

The rehab setting is where I have traditionally considered music to be “used as a tool.” In actuality, though, it’s not. You cannot remove the humanness of the process, the therapeutic element. Even if the music is structured in a more prescribed way (e.g. pre-determining the musical elements—tempo, dynamic level, meter—based on the assessment), the music therapist is still responsive therapeutically and musically to the client’s needs in that moment.

I also see this reflection as parallel or perhaps even the same as that of music in verses music as therapy. Just a couple years ago, I wrote that I saw a role for both in music therapy. But if music IN therapy is likened to playing music and music AS therapy is likened to engaging in music . . . well, that changes things for me.

I don’t have any clear-cut answers or insights at the moment. This is an ongoing journey of reflection for me. But I appreciate the opportunity to deepen my understanding just a bit more.

It’s a step, anyway.


{ 3 comments… read them below or add one }

Brian Abrams July 25, 2014 at 3:54 pm

Thanks for your essay in response to Noah’s essay, Kimberly–and I appreciate how you have openly shared how it has informed your thinking. I, too, found Noah’s piece enormously well articulated and thought provoking, and worthy of continued dialogue and discussion around the distinctions between the conservatory-based, performance paradigm of music and the therapy-based, clinical musicianship of health musicking.

With respect to music “in” versus music “as” therapy, I have always appreciated what Bruscia has written on this particular topic. In fact, in his new 3rd edition of “Defining Music Therapy” (Bruscia, 2014), hot off the presses (!), he shares a passage which I find particularly helpful in making the distinction:

“Perhaps the best way to understand the difference is to compare them in terms of the focus of therapy and the context which facilitates that focus, as they evolve from one moment to another. When music is being used as therapy in a session, music is the focus of the therapeutic experience and thereby serves as the primary medium or agent for therapeutic interaction and change; the personal relationship between client and therapist and the use of other arts or therapeutic modalities provide a context that facilitates this focus. During the same session, or in another session, music may also be used in therapy. Here the focus of the experience is on either the personal relationship between the client and therapist or an experience in a modality other than music; music provides the context or background that facilitates this focus. Thus, when used as therapy, music is the foreground of the experience, and the relationship and other modalities are in the background; when used in experience, while the relationship and other modalities serve as the foreground” (pp. 62-63).

To me, this seems like a somewhat different sort of distinction than the one Noah is making between performance and clinical musicianship/health musicking. Anyway, I consider it meaningful “food for thought”! Thanks again for sharing this blog entry.

Brian Abrams

Kimberly July 28, 2014 at 11:23 am

Brian, thank you for your comment and for sharing the excerpt from Bruscia’s new edition (which I am excited to read!). I can see based on this quote how these two constructs can be different. On initial reflection, it seems like Bruscia’s description is in line with some of my thoughts—or more accurately my thoughts are in line with his description—about the music as and music in therapy falling on a continuum. I look forward to continuing this discussion and line of inquiry.

All the best,

Brian Abrams July 28, 2014 at 1:14 pm

Yes, definitely a continuum, which is what I appreciate about how Bruscia frames the “in” vs. “as” distinction. Based upon what Noah and you have shared, perhaps it is likewise possible to conceptualize the “Music as Tool” and “Music as way of Being-With” as its own, independent, yet intersecting, continuum. Definitely an interesting line of conversation. Thanks again for the blog post.

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