As a trained music therapist and a professional performing musician who works in healthcare settings, I am often asked ‘What is music therapy?’ and ‘What is the difference between music therapy and music in healthcare?’
The work done by musicians in healthcare is often inaccurately described as ‘music therapy’ and many animated discussions can be heard at arts and health conferences searching for similarities and differences between the two.
Evaluations of music programmes in healthcare settings often describe outcomes that relate to emotional and mental health, but I think this shared vocabulary contributes to confusion that exists about these fields. A look at the thought processes, approaches and intentions involved in both practices may hopefully provide greater clarity.
When I am involved in music in healthcare, I combine performance with participative music making. Generally working with large groups of at least fifteen people, I design activities to enable participants to engage with music. For example, we might compose new material, or improvise on pre-existing music of interest to participants.
As a music therapist, I most often work with individuals. My purpose is to respond musically to the client. As a result, the musical content may often sound unstructured, directionless, perhaps even unpleasant. However, as a music therapist, I am not concerned with the musical outcome.
The reason for this is that the primary ‘language’ of music therapy is free improvisation. This produces an organic conversation-like interactive process. Known as ‘clinical improvisation’, the focus is on responding to the internal world of the client, rather than to musical elements such as melody, rhythm or harmony.
These mutually reciprocal responses between therapist and client allow for great freedom in any given moment and an understanding that the music created is neither right nor wrong – it just is. This acceptance of what the client plays or says reflects an acceptance of who they are and what they can do.
As the ‘language’ of music therapy is non-verbal, it has no ‘concrete’ cognitive meaning, but has great power to convey emotion, thus enabling a client to make deeper connections with others (an inability that is often at the root of psychiatric disorders). A client’s internal and unconscious world is revealed through the music they make. This provides emotional expression for the client and information for the therapist.
When performing as a musician in a healthcare setting, my primary considerations are generally artistic and social. As I interact with the group, my thoughts are about what to play next or where a particular improvisation or activity might go for the best outcome for the group. While I do have to approach this sensitively, for example, judge how long to engage with different individuals to avoid pressurising anyone or abandoning someone who might need more encouragement, the focus is on producing a satisfying shared artistic outcome rather than extracting unique information and insights that might be contained in the individual’s clinical process. At its best music in healthcare walks a careful tightrope between musical ambition and inclusive collaboration between musician and participants calling for considerable imaginative resources on behalf of the musician.
When working as a music therapist, I find myself giving priority to thoughts of interpersonal issues over musical issues. I emotionally ‘tune into’ the client and the atmosphere in the room. To respond sensitively and appropriately requires a deep focus. I allow the music to flow through me rather than plan its structure. My aim is to communicate and I do this best without micromanagement of the sounds to produce a particular end.
Music therapy sessions are not ‘directed’ by the therapist, but by the information and suggestions contained in the musical events and responses that occur. This openness allows new ‘discoveries’ to emerge in their own time. Making attempts to apply control over this process for the production of a particular external ‘sound outcome’ would go against its very nature.
Playing music in a healthcare setting is, on the other hand, a social and cultural occasion with everyone contributing to the outcome. A healthcare artist, therefore, does not need to consider particular therapy techniques, clinical ‘boundaries’ or other responsibilities acquired through training and experience that make the therapy process possible. While it is always important to be aware of any social or emotional issues present, especially when providing support for vulnerable individuals, artists in healthcare do require sensitivity and do provide enormous therapeutic benefits, but it is not the same thing as therapy.
Music therapy is ‘one-sided’. The client shares information about himself. The therapist does not. To do so is believed to be inappropriate and interfering with therapy. Unlike the social situation of music in healthcare where people share information and a joint outcome, the therapy ‘relationship’ is almost artificial: a ‘tool’, a kind of ‘applied conversation’ to produce clinical aims. In other words, this ‘tool’ of shared improvised music is used in the exploration of a specific client’s issues in pursuit of that client’s clinical goals.
In practice, I never mix the two professions. I am either employed as an artist or as a clinician and this is determined by the commissioner of the work, so that my responsibilities and intentions are clear from the outset.
The experience of working in both of these areas has been invaluable for me in terms of my continuing professional development. Music therapy has taught me that each musical event has its own inherent timing and that we are wise not to try to control a process directly, whether clinical or artistic. From working as a musician in healthcare I have learned that making music has value for its own sake and this has informed my thinking as a therapist.
Ultimately, I believe that when life becomes difficult, engaging in any art form can give us a reason to keep living. Being creative is part of being human and not having artistic opportunities is a deprivation. Both music therapy and music in healthcare offer different but related benefits. However, I believe that greater understanding about the nature of both practices can lead to greater clarity in the expectations and engagement of commissioners and participants/clients.
Aingeala De Búrca is a Musician and Music Therapist. During her early career, she played electric violin in a number of rock bands. Her training as a music therapist reignited a deep interest in the potential for communication and expression to be found in shared improvising and performance. She combines a freelance career as a multi-genre violinist with facilitating community music projects in a wide range of healthcare and educational settings.