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On Defining Community Music Therapy

"What is going on here?"

This is the opening question of Pavlicevic and Ansdell's (2004) book Community Music Therapy. Even Ruud's recent contribution to the Voices discussions about community music therapy seems to me to be written as a response to this book and to the fact that there is no definite definition of community music therapy given in it.

Ruud writes:

Our wise colleague in Philadelphia, Ken Bruscia, once remarked in one of his lectures that music therapists need boundaries. That was one of the reasons he wrote his Defining Music Therapy. Witnessing the remarkable expansion in the discourse field someone has named "community music therapy" (in Rachel Vernay's [sic] kitchen) one must clearly admit that this main character trait of the music therapist once again has been demonstrated. Community music therapy (cmt) has been presented being/not being a model, a paradigm, a tree, a ripple effect, a performance oriented approach, an ecological model, a system theory based approach, a group of people marching under a new banner, a musical milieu therapy, a balloon, and so on. In this rhetoric, followers around the world are standing up, witnessing how for years they all have been practicing community music therapy without really knowing it (Ruud, 2004).

I agree with Ruud that the increasing use of the term community music therapy invites us to discuss what the concept of community music therapy could be. In this situation, a contribution from a veteran scholar such as Even Ruud is of course very welcome, and I will try to develop a response to it, after haven given it a context.

Why any Definition in the Garden of Trees and Baloons?

It could be argued that the whole business of defining community music therapy is somewhat suspicious, since a) community music therapy is about sensitivity to context and therefore must be defined in context, and b) the discourse on community music therapy is only beginning to develop, so any definition runs the risk of narrowing things down before the dialogues have even started.

Personally, I welcome new definitions of community music therapy, since objection a) already in itself includes an implicit definition and since my response to objection b) is that new definitions could also operate as food for thought and dialogue. I would, however, suggest that new definitions are more helpful if they are based in a review of existing literature. What are the qualities and shortcomings in the existing definitions of community music therapy?

Ruud's contribution is given in the context of an internet discussion, so it would be unreasonable to request that it included a complete literature review. I still find it somewhat problematic that the context he develops for his definition is the forest of metaphors that has grown in the recent literature on community music therapy. This forest - which by the way would be an interesting object of study in itself - is hardly about defining community music therapy. As far as I can see, the wide range of metaphors that has been developed represents attempts of illuminating various experiences and aspects of community music therapy. Previous attempts of defining community music therapy do exist, however. I have therefore chosen to develop an appendix, where a list of some existing definitions is given. As I have been involved in the process of defining community music therapy myself, I do not present this list with the purpose of discussing which definition is the more helpful or suitable. My intention has been a) to illuminate that community music therapy is more established as a term than what Ruud indicates when he launches his definition, and b) to use the list as a foundation for a new reflection upon how some of the basic ideas behind the idea of community music therapy could be communicated.

A History of Community Music Therapy?

Ruud suggests that the term community music therapy was born in Rachel Verney's kitchen in 2000. For all I know, this kitchen and the moment referred to may have been important in the British context (see Pavlicevic & Ansdell, 2004, p. 19) and I do consider the current British initiatives for community music therapy to be vital and stimulating. We should not forget, however, that the term community music therapy was already in use in the 1960s and 1970s and then (after a period with much relevant practice but with less documentation and discussion) had a revival in the 1990s. What is new since 2000 is a) there is now an international dialogue and debate about the concept and the practices it refers to, and b) research and theory development is now being done and published in relation to community music therapy. A mutual process seems to be established, where the ongoing debate informs the research and theory development that is being done, and vice versa.

In "The Relentless Roots of Community Music Therapy," previously published in Voices (Stige, 2002), I have tried to show how community music therapy has roots in the work of music therapy pioneers such as for instance Schwabe and Seidel in the German context, Ruud and Aasgaard in the Norwegian context, and Tyson and Kenny in the North American context. There are also community-oriented aspects in the work of international pioneers such as Juliette Alvin, Nordoff & Robbins, and Mary Priestley. In addition, strong community-oriented traditions exist in both the Australian and the Canadian contexts, and recent developments in all continents (including Africa and Asia) are also highly relevant. My impression is that the emerging international discourse on community music therapy may have potentials for building connections between previously separate discourses and practices in the broader field of music therapy.

I do not think, then, that community music therapy could be written off as a new fancy idea or as a fancy name for what most music therapists have been doing most of the time anyway. To me, it is more plausible to suggest that community music therapy may be understood as a set of responses to challenges given by contemporary (international) developments in society and culture, such as the processes of modernization (including aspects such as individualization, specialization, and professionalization). If this thesis makes sense, we should expect to find similar developments in related disciplines, and I do think it is possible to find this. If we take a look at a larger and more established discipline such as psychology, we will see that it has had a subfield called community psychology for more than 40 years now (Nelson & Prilleltensky, 2005).

Some Thoughts on Ruud's Definition

Even Ruud's new definition of community music therapy is:

Community music therapy, then, may be defined as "the reflexive use of performance based- music therapy within a systemic perspective" (Ruud, 2004).

Having established the context in which I read this definition, I will develop a response to it. My first thought is that it is impressively short and distinct. In this respect it is only surpassed, I believe, by Stuart Wood's description of community music therapy as "joined-up music therapy" (see the appendix).

Some of the points that Ruud makes are, in my view, obviously central, such as the relevance of systems theories and the importance of reflexivity. My concerns relate to his focus upon performance as a defining characteristic of community music therapy, and I will concentrate on this issue. Ruud writes that a performance-based approach is not new, but that:

.many of us have constructed improvisation and listening as the main forms of doing music therapy, thus downgrading the importance of performance and product. Cmt gives credibility to a performance-based approach. I am aware that cmt also applies other methods of mt. However, without the public performance, there will be no exchange with a community (Ruud, 2004).

If we compare Ruud's definition to the other existing definitions of community music therapy (see the appendix), we will see that his definition is unique in that it is referring to a specific method or type of activity. I don't think this is a detail. Rather, I think it is a problem, and I have three arguments to support this contention:

1) There is more at stake than the acknowledgement and inclusion of a method or type of activity. Two of the aspects that I find more central are a) the ethical and practical boundaries of music therapy practice are being negotiated within a new framework of thinking, b) the role of clients and music therapists (in relation to each other and to society at large) is being negotiated in new ways and within new contexts.

2) It is too narrow to link specific methods or types of activities to specific areas of practice. Music listening is not limited to medical music therapy, improvisation is not limited to music psychotherapy, performance is not limited to community music therapy, etc. Music listening, group improvisation, community singing, and dance are among the other methods or types of activity that could generate a sense of community and therefore be of relevance for community music therapy. I simply do not think it's precise to claim that "without the public performance, there will be no exchange with the community" (but see my comment below about the concept of performance).

3) The clinical hazards involved when therapists and clients line up for public performance (Ruud refers to Turry's interesting discussion of this) suggests that it would be ethical dubious to establish performance as the defining method of community music therapy. It is a suitable method for some clients in some contexts, while it is irrelevant or unhelpful (or worse) in other situations. In this respect I find Ansdell's (2003) "anti-definition" of community music therapy as an "anti-model" helpful. It doesn't exactly define community music therapy, but it conveys values that I find central. In encouraging "therapists to resist one-size-fits-all-anywhere models" Ansdell's statement, to me at least, suggests a participatory approach.

I agree with Ruud, however, that the potential value of performance is one of the things that have been brought to the foreground in the texts about community music therapy. In order not to restrict the focus to just one form of musical activity or method, I would suggest, however, that it would be fruitful to link the idea of performance more explicitly to a sociological conception. In the same way as we have a narrow and broad concept of culture as the arts and culture as a way of living, we have a narrow and a broad concept of performance as presentation of art for an audience and performance as presentation of the self in everyday contexts. The latter meaning is especially linked to the sociology of Erving Goffman (1959/1990), and I suggest that a broader concept of performance is probably more central to community music therapy than the narrower one (important as it may be). A broad conception of performance would of course not exclude the interest for the narrower conception and the practices it refers to.

This suggestion is of course foreshadowed by Small's (1998) discussion of music as performance and of Aldridge's (1996, p. 20) idea of health as performance. And, as most readers of Voices will know, the work of Ruud himself (1980, 1998) has been crucial for the integration of sociological perspectives to music therapy.

Defining Values

I have read Ruud's contribution as an attempt of challenging the emerging discourse on community music therapy by offering a narrow and specific definition of the field. While I find aspects of his definition problematic, I acknowledge the need for clarifying and communicating central ideas on what community music therapy is or could be. In reviewing the existing definitions (see the appendix), I will therefore conclude by offering some suggestions in relation to this.

Community music therapy is ecological: This is explicit in Bruscia's (1998) discussion of community music therapy, and implicit in most definitions (as in Wood's phrase "joined up" and in Ansdell's phrase "follow where the needs of clients, contexts and music leads").

Community music therapy is music-centred: This is made explicit in the first statement of Ansdell, Pavlicevic, Procter & Verney, quoted in Ansdell (2002, p. 120) and it is implicit in most other definitions (by music-centred I do not refer to any specific notion of how to use music in music therapy, I simply suggest that interpersonal and social change through musical change is central to community music therapy).

Community music therapy is value-driven. This is explicit and implicit in most definitions, such as in Bruscia's (1998, p. 237) focus upon inclusion and valued participation in a community, in Ansdell's (2002, p. 120) critique of overly individualized treatment models, and in Stige's (2003, p. 254) focus upon collaboration and a participatory approach.

In sum, then, I suggest that (as practice) community music therapy is ecological, music-centred and value-driven. This statement is not intended as a new definition, but as a phrase highlighting three of the keywords I find central for reflection on future developments. I am of course not suggesting that these keywords are exclusive to community music therapy (other practices may also be music-centred, for instance), but I am suggesting that these keywords are central to community music therapy in a specific way.

Some may find it controversial to suggest that a field of professional practice is value-driven. In response to this, I suggest that a comparison with the discussion on values in psychology could be relevant. Nelson and Prilleltensky write:

In striving to become a science, psychology, particularly applied psychology, has ignored the moral, ethical, and value dimensions of its work. Failure to attend to value issues has led to psychology upholding the societal status quo . and to the continued oppression of marginalized people (Nelson & Prilleltensky, 2005, p. 32).

In response to this, Nelson and Prilleltensky suggest that community psychology should aim at taking a critical and constructive role in promoting equity, social change, and liberation. Going back to community music therapy, I think it would be presumptuous to suggest that it represents equity, social change, and liberation, but if our critique includes some self-critique we could try to change the world, if only a bit (Stige, 1993/1999).

References

Aldridge, David (1996). Music Therapy Research and Practice in Medicine. From Out of the Silence. London: Jessica Kingsley Publishers.

Ansdell, Gary (2002). Community Music Therapy & The Winds of Change. [online] Voices: A World Forum for Music Therapy. Retrieved December 8, 2004, from http://www.voices.no/mainissues/Voices2(2)ansdell.html ( A revised version is published in Kenny, Carolyn B. & Brynjulf Stige (eds.) (2002). Contemporary Voices of Music Therapy: Communication, Culture, and Community. Oslo: Unipub forlag).

Ansdell, Gary (2003). Community Music Therapy: Big British Balloon or Future International Trend? In: Community, Relationship and Spirit: Continuing the Dialoge and debate. London: British Society of Music Therapy Publications.

Freesearch Dictionary [online]. Retrieved December 8, 2004, from: http://www.freesearch.co.uk/dictionary/joined-up.

Goffman, Erving (1959/1990). The Presentation of Self in Everyday Life. London: Penguin Books Ltd.

Nelson, Geoffrey & Isaac Prilleltensky (2005). Community Psychology. In Pursuit of Liberation and Well-being. New York: Palgrave MacMillan.

Pavlicevic, M. & Ansdell, G. (eds.) (2004). Community Music Therapy. London: Jessica Kingsley Publishers.

Ruud, Even (1980). Music Therapy and its Relationship to Current Treatment Theories. St. Louis, MO: Magna-Music Baton.

Ruud, Even (1998). Music Therapy: Improvisation, Communication and Culture. Gilsum, NH: Barcelona Publishers.

Ruud, Even (2004). Defining Community Music therapy [online]. Voices: A World Forum for Music Therapy, Moderated Discussion. Retrieved December 10 from http://www.voices.no

Small, Christopher (1998). Musicking. The Meanings of Performing and Listening. Hanover, NH: Wesleyan University Press.

Stige, Brynjulf (1993/1999). Music Therapy as Cultural Engagement. Or: How to Change the World, if Only a Bit. Paper presented at the 7th World Congress of Music Therapy, Vitoria-Gasteiz, Spain. Reprinted in: Aldridge, David (ed). (1999). Music Therapy Info, Vol. II, CD-Rom.

Stige, Brynjulf (2002). Culture-Centered Music Therapy. Gilsum, NH: Barcelona Publishers.

Stige, Brynjulf (2003). Elaborations toward a Notion of Community Music Therapy. Oslo: Unipub.

Turry, Alan (no date). Performance and Product: Clinical Implications for the Music Therapist [online]. Retrieved December 8, 2004, from http://www.musictherapyworld.de/modules/archive/stuff/papers/perforprod.doc

Tyson, Florence (1968). The Community Music Therapy Center. In: Gaston, E. Thayer (ed.). Music in Therapy. New York: Macmillan Publishing.

Appendix: Some Existing Definitions of Community Music Therapy

Below I have developed a chronological list of some definitions that have been given of community music therapy. The list does not claim to be comprehensive, but should illuminate some of the ideas that have been in circulation (in addition there is a long series of related contributions where the specific term "community music therapy" is not used but where related ideas are discussed, see "The Relentless Roots of Community Music Therapy (Stige, 2002). For references to the definitions given below, see the reference list above.

In Defining Music Therapy, Kenneth Bruscia (1998) presents six different areas of practice in music therapy. A summary of his notion of area of practice would be that an area is defined by what the primary clinical focus is, that is; by what the foreground of concern for the client, the therapist, and clinical agency is. Of particular relevance are: The priority health concerns of the client and of the agency serving the client, the goal of the music therapist, and the nature of the client-therapist relationship (Bruscia, 1998a, pp. 157-158). Bruscia then treats community music therapy as a sub-area to the area (at the intensive level) of ecological practices:

In Community Music Therapy, the therapist works with clients in traditional individual or group music therapy settings, while also working with the community. The purpose is twofold: to prepare the client to participate in community functions and become a valued member of the community; and to prepare the community to accept and embrace the clients by helping its members understand and interact with the clients (Bruscia, 1998, p. 237).

To my knowledge, this is the first formal definition of community music therapy given in the literature. What Bruscia refers to, however, is not his own creative innovation, but a sub-tradition to music therapy with some quite old roots. Bruscia's definition is, by the way, narrower than those that have been produced after 2000, which I assume some will see as an asset and others as a limitation.

The text that probably more than any other text did put community music therapy on the international agenda of music therapy, was Gary Ansdell's (2002) "Community Music Therapy and the Winds of Change." In this essay Ansdell suggests that community music therapy is about exploring a broader spectrum of the individual-communal continuum, in response to the needs of their clients. Ansdell launches community music therapy as a "third way" between community music and what he calls the consensus model of music therapy, and presents the following definition:

Community Music Therapy is an approach to working musically with people in context: acknowledging the social and cultural factors of their health, illness, relationships and musics. It reflects the essentially communal reality of musicking and is a response both to overly individualized treatment models and to the isolation people often experience within society.

In practice Community Music Therapy encourages Music Therapists to think of their work as taking place along a continuum ranging from the individual to the communal. The aim is to help clients access a variety of musical situations, and to accompany them as they move between 'therapy' and wider social contexts of musicking.

As such, Community Music Therapy involves extending the role, aims and possible sites of work for music therapists - not just transporting conventional Music Therapy approaches into communal settings. This will involve re-thinking not only the relationship between the individual and the communal in Music Therapy, but also taking into account how physical surroundings, client preferences and cultural contexts shape the work.

Community Music Therapy aims to develop theory consistent with its view of musicking as an engaged social and cultural practice, and as a natural agent of health promotion (formulated by Ansdell, Pavlicevic, Procter & Verney, 2002, quoted from Ansdell, 2002, pp. 120-121).

In Culture-Centered Music Therapy, which was published the same year, community music therapy is defined in the following way:

Community Music Therapy: Music therapy practices that are linked to the local communities in which clients live and therapists work, and/or to communities of interest. Basically two main notions of Community Music Therapy exist: a) music therapy in a community context, and b) music therapy for change in a community. Both notions require that the therapist be sensitive to social and cultural contexts, but the latter notion to a more radical degree departs from conventional modern notions of therapy in that goals and interventions relate directly to the community in question. Music therapy, then, may be considered cultural and social engagement and may function as community action; the community is not only a context for work but also a context to be worked with. Both variants of Community Music Therapy suggest the relevance of project-oriented approaches in which sometimes the therapy process of several groups or individuals may belong to the same community music project. Project-oriented approaches usually require untraditional therapist roles and tasks (including project coordination, interdisciplinary consultation, and local political information and action). Community Music Therapy requires a broad spectrum of inter-disciplinary theory in order to be well founded, and relevant models of research include ethnography and participatory action research (the latter being especially relevant for the more radical definition of Community Music Therapy). Community Music Therapy is necessarily ecological, since individuals, groups, and communities function in and as systems (Stige, 2002, p. 328).

In the thesis Elaborations toward a Notion of Community Music Therapy, published a year later, this is examined critically and a conclusion suggesting that implications for discipline and profession needed to be included in a definition is developed:

Community Music Therapy may be defined at three levels, as a notion referring to an area of practice and to probable future developments of a sub-discipline and a professional specialty:

Community Music Therapy as an area of professional practice is situated health musicking in a community, as a planned process of collaboration between client and therapist with a specific focus upon promotion of sociocultural and communal change through a participatory approach where music as ecology of performed relationships is used in non-clinical and inclusive settings.

Community Music Therapy as emerging sub-discipline is the study and learning of relationships between music and health as these develop through interactions between people and the communities they belong to.

Community Music Therapy as emerging professional specialty is a community of scholar-practitioners with a training and competency qualifying them for taking an active musical and social role in a community, with specific focus upon the promotion of justice, equitable distribution of resources, and inclusive conditions for health-promoting sociocultural participation (Stige, 2003, p. 254).

One of the most recent contributions to the community music therapy literature, Pavlicevic and Ansdell's (2004) book Community Music Therapy, interestingly does not include any very specific definition. Instead, Ansdell refers to a (anti-)definition he gave in the Voices discussions in 2003:

Community Music Therapy is an anti-model that encourages therapists to resist one-size-fits-all-anywhere models (of any kind), and instead to follow where the needs of clients, contexts and music leads (Ansdell 2003, in Pavlicevic & Ansdell, 2004, p. 21).

Pavlicevic and Ansdell's book also includes striking characterizations and "mini-definitions," such as one given by Stuart Wood:

Community Music Therapy is joined-up1 music therapy (Stuart Wood, in Pavlicevic and Ansdell, 2004, p. 21).

The most recent definition, then, is given by Even Ruud:

Community music therapy, then, may be defined as "the reflexive use of performance based- music therapy within a systemic perspective" (Ruud, 2004).