Among the more pervasive understandings of how and why music therapy works—the kind represented in the popular news media, for example—is one generally analogous to a biomedical and/or behavioral practice, wherein natural scientific mechanisms resulting from manualized, procedural interventions (preferably in measurable dose-response proportions) serve as the bases for health outcomes. In this understanding, aesthetic (artistic) and relational (roles, interpersonal dynamics, empathy, etc.) components of music therapy are sometimes acknowledged, but are generally viewed as additional variables in the functional mechanisms that bring about the target outcomes (much in the same manner as medicinal adjuvants help facilitate a target physiological response). Moreover, from this perspective, the sort of evidence prized as most valuable and legitimate is of the positivist, natural science variety supports assertions about the "truth" of music therapy's technical effectiveness.
But does it really make any sense to assert that music therapy works as a technical, natural science?
If we grant that music is at the heart of music therapy, then the question of what "works" means, as applied to music. As is commonly asserted, it refers to the science of how certain sounds (or the behavior of producing of those sounds) impacts organisms in certain, systematic ways (typically, on a neurophysiologic level). Yet, insofar as music is art, music is a co-participatory encounter among persons—human agents—situated within individual identities, shared communities and cultures, and relational (or social) meaning contexts. It is an act of being that people construe, express, and create together (as listeners, performers, improvisers, and composers), in lived ways. Is the meaning of "work" on this level something that can be understood, influenced, impacted, etc., by the mechanisms of sound being produced, propagated, and transformed into electrochemical impulses? A common assumption is that one understands how wholes work by understanding how their parts (or mechanisms) work. But what exactly is the relevance of physics, auditory processing cortex, and limbic systems shed upon Mozart's Magic Flute (by the same token, what do optics, the chemistry of pigment, and the visual cortex truly reveal about Da Vinci's Vitruvian Man—and what does understanding paper, ink, and the verbal language processing centers of the brain have to do with understanding Homer's Odyssey)? If music cannot ultimately be understood according to how its parts work, then why would it make sense to understand the way music therapy works in terms of its parts?
As I reflect upon my own experiences of working with clients (from neonatal intensive care, cancer care, psychiatric, individual music psychotherapy, and other contexts), as well as my own experiences of being a client, I have never found the work in music therapy to be located in any sort of mechanism. For me, the work is located in human relationship, on the level of persons—persons who utilize opportunities for co-creating processes and outcomes that address clinical needs. I have never experienced the music as a thing that works, but rather as a way in which the client works, with the help and support of the therapist; nor have I ever experienced music as effective (even when it is, as I like to pun, very affective!), but rather have experienced the client working effectively, and the therapist helping effectively, in music.
Put another way, I have generally understood the work in the sense of a work of art; or, in the context of music therapy, as musical works of health. The Latin term for work, opus—or, in the plural, opera—seems to capture this understanding well. From this point of view, it is not the music therapy that works—rather, it is the music therapy that creates opportunities for client and therapist to create works ("opera") of health together. Thus, I believe it valuable to consider opera-tionalizing music therapy, not as a way that works, but as a way of working, wherein the locus (and ownership) of the work resides with the human agency of the client, as supported by the therapist, with the evidence of such work embodied in the co-created musical health processes and outcomes (via narratives, case studies, phenomenologies, ethnographies, etc.).
So, does it really work? In the end, that may not be the most relevant question about the practice of music therapy. While music therapy may be popularly understood as a way that works (a mechanism), it may be understood more compellingly, and with greater internal consistency (concerning persons and the nature of music), as a way of working. Likewise, in research and in public representation, there may be value in a growing emphasis upon recitals of the works (opera) in our music therapy portfolios.
Abrams, Brian (2012). Does It Really Work?. Voices: A World Forum for Music Therapy. Retrieved May 20, 2013, from http://testvoices.uib.no/?q=fortnightly-columns/2012-does-it-really-work