Voices ResourcesA website for the worldwide community around the journal Voices: A World Forum for Music Therapy

Overview

Music therapy in Taiwan continues to harvest the fruits of labor. More professionals with various levels of music therapy training are returning to Taiwan from Australia, England, Germany, Japan, and the United States to fulfill their passion for the profession in clinical and/or academic settings. Music therapists regularly offer workshops for caregivers and educators who work with children with developmental delays and learning disabilities, adolescents with emotional disturbances, senior citizens, and victims of domestic violence (Taipei's Women Rescue Foundation, n.d.), and for individuals who would benefit from stress management (School of Continuing Education Chinese Culture University, 2006; Peitou Womenweb, 2006) To take advantage of the multi-sensory avenues of communication in music therapy that would compensate for limitations due to disabilities, grants are available to sponsor one-school-year training for counselors with and without visual loss (Tamkang University Resource Center for Visual Loss Students, 2006, Taipei Fubon Charitable Foundation, 2005). The public now has a better understanding that music therapy is the clinical and evidenced-based application of music experiences to achieve individualized goals (AMTA, 2005) and is gradually departing from the lingering misconception of "music therapy = Music Prescription (Music Rx)" (Lee, 2003). [Music Prescription (Music Rx) refers to the use of music listening experience for curative purposes that are not necessarily evidence based - see Lee, 2003] Increasing numbers of high school and college students now express interest in music therapy as a prospective career choice. As study abroad is not always an option, there is a need for more preparatory programs available in Taiwan (Yang & Pan, 2005).

Professional Development

In response to the aforementioned demand, the Music Therapy Association of Taiwan (MTAT) contracted with the Extension of Fu-Jen Catholic University to offer music therapy classes for credit beginning in 2004. The ultimate goal of this project was to progress toward a music therapy certification system via a series of required courses. Although the certification system has not yet been initiated, these courses, which include Introduction to Music Therapy, Keyboard Skills, Guitar, Music Therapy Techniques, etc. provide a head start for those who plan to pursue undergraduate music therapy degrees abroad. These courses are also provided for those who are at least 18 years of age and who desire music therapy training beyond the introductory courses. MTAT also continues its mission of providing continuing education for music therapists by sponsoring workshops and conferences that feature local as well as international music therapy clinicians, including Prof. Gao-Tian of the Central Conservatory of Music at Beijing (2004) and Prof. Emeritus Joseph Moreno of the Moreno Institute for Creative Arts Therapies (2004).

Two other universities have also developed curricula that allow students to major in or have an emphasis on music therapy. In 2003, after featuring a series of music therapy seminars, the Graduate Institute of Humanity in Medicine of Taipei Medical University offered two music therapy-related lecture courses (Medicine and Music, and Music Therapy) as elective options (Taipei Medical University, n.d). Students may also choose music therapy as a focus for their master thesis. To be admitted to the program, a candidate with a bachelor's degree or equivalent must rank highly on both the written and oral admission examinations, which consist of English, Medical History, Anthropology of Medicine, Medicine and Social Sciences, and Medicine and Arts & Humanities. Although not stated on any page of the university's official website, and considering that this is the first higher education institute offering music therapy classes in the graduate level (Chang, 2004), the degree plan "music therapy major" was referred to among the graduates who took courses Medicine and Music and/or Music Therapy (Musicdog Music Workshop, n.d.). The program was "Music Therapy Division, Graduate Institute of Humanity in Medicine" (LiHsuen, 2005). Although the program does not offer fieldwork experience or many other subjects crucial to music therapy studies - for example, music therapy theories and techniques, competencies and ethics and music therapy research - it does provide healthcare professionals with a general appreciation for music therapy.

In 2004, the Tainan National University of the Arts also began an undergraduate music therapy program. This is the only comprehensive, degree-granting music therapy program in Taiwan for the entry-level music therapist. Adopting the undergraduate music therapy curricular design used in the US, this degree program requires four years of study. Students have their first clinical placement in their junior year. To be admitted to the program, one is examined as other prospective students in music with an additional requirement of Natural Sciences (Biology) and a written Statement of Purpose (College Application Admission Center, 2006). The program is currently taught by a U.S. trained adjunct instructor who holds a Masters degree.

Professional Status

As the professional development of music therapy in Taiwan is moving forward, the professional status of music therapists in Taiwan now faces a new challenge. Due to its interdisciplinary nature and not-yet-established legal regulation, music therapy is in danger of being administratively merged into or marginalized by other healthcare professions. To better understand the struggle, one has to be aware that there is no clear distinction in definition between "medical treatments" and "therapy" in Taiwanese medical culture (Lee, 2006). This leads to a conclusion that therapeutic interventions should be implemented by medical professionals. In spite of this assumption, the fact that music therapists are yet to be classified as medical professionals with required legal endorsement results in an open discussion by already state-regulated healthcare professionals and legislators concerning the legitimacy of music therapy practice. Medical administrators have been lobbied to interpret music therapy and other expressive arts therapies as examples of "Recreation Therapy," which is currently listed within the scope of occupational therapy practice. A former executive board member of MTAT once proposed a personal definition of music therapy during an interview that, according to his clinical observation, "music therapists, as well as [other] state-certified medical professionals, apply therapeutic-oriented music activities in their clinical practice for promoting and maintaining [patients'] mental and physical health" (Chung, 2005). This personal statement, despite the initial intention behind it, clouds the battle for the legitimacy of music therapy as its own profession with further ambiguity.

All these phenomena are rooted in a fundamental concern that "music therapist" needs to be better defined incorporating the unique medical culture in Taiwan within a framework of functional music competencies. It is still to be determined which competencies a professional music therapist in Taiwan should acquire; however, the importance of a music therapist's ability to effectively and efficiently apply musical experiences to achieve individualized goals has been de-emphasized or excluded in discussion especially when non-music therapists attempt to interpret the profession. The musical ability distinguishes music therapists from therapists/medical professionals in other disciplines. The latter may provide a limited variety of musical experiences to support their treatment procedures, but it is through the sophisticated use of musical experiences that actual music therapy treatments are delivered. Sufficient training in musicianship that allows a music therapist to create immediate quality musical experiences, observation skills sensitive to musical cues, and leadership skills to facilitate the music making process for therapeutic purpose summarizes only part of the scope of competencies expected of a music therapist. This explains why experienced music therapists with appropriate training raise ethical concerns when people who have attended few classes or workshops, or co-authored scholarly writing applying the concept of music therapy claim they are music therapists. In contrast, such individuals feel they were really "trained in music therapy" and feel confident in implementing what they believe are "music therapy techniques." For instance, a nursing professor who has only attended workshops instead of all levels of Guided Imagery and Music (GIM) training was the instructor of a GIM workshop (Taiwan NPO Information Center, 2006). The struggle is also observed in the music therapy preparatory curricular design. Proposed course titles in Taiwan may replicate what was offered where the music therapy instructor was educated abroad, but the content may be substandard by comparison. This causes apprehension in music therapy practitioners whether future graduates will be ready to face the challenges of the clinical world. (Wu, Chia-Hue, personal communication, April 15, 2006). This leads to another "mystery to be solved," i.e. the professional classification of music therapy. Does music therapy belong to the professional domain of music, mental health, (special) education, medical/healthcare, or another area (Her, 2004)? Would regulation as medical professionals provide a more promising and legitimate future for music therapists in Taiwan? Are educators and clinicians ready for future challenges in training so music therapists will not be marginalized? These questions are expected during the process of legal advocacy.

Economic, Social and Cultural Factors in Music Therapy Development in Taiwan

Job prospects for music therapists in Taiwan have improved since the 2003 review, regardless of the aforementioned challenges. More institutions and organizations feature workshops in music therapy. Parents of children with developmental delays, learning disabilities, or social concerns are increasingly aware of the effectiveness of music therapy and now request this intervention more often for their children. This may also be facilitated by the "Child's needs go first" attitude (Lee, 2003). The number of hospitals that offer music therapy, usually as a division of pediatric rehabilitation departments is growing as well. Music therapy services to residents in long-term care facilities and patients receiving hospice are also increasing. Many experienced music therapists are facing an overwhelming workload. New social welfare policies support music therapy service to under-privileged individuals and groups requiring financial assistance from the government. Although most music therapy services still rely primarily on private payment, local governments now list music therapy as an eligible service for monetary supplement when a child is certified to receive early intervention, for example: $5,000 NT ($151 US)/month per child for low income and foster families, or $3,000 NT ($92 US)/month per child for others (Yunlin County, 2006; Hualian County, 2005; Taipei County, 2005). Music therapy service that is eligible for National Health Insurance reimbursement is only available at few facilities because the service requires co-endorsement by another state-regulated healthcare practitioner. Non-profit organizations support music therapy workshops with governmental funding (Department of Social Affairs, 2005) and/or registration fees of the attendee.

The ineligibility of music therapy for National Health Insurance reimbursement results in a "sweet irony." For-profit institutions in cities with higher consumer spending welcome privately paid music therapy service as it generates more income. In contrast, treatments relying on National Health Insurance would have to be delivered more frequently in order to be financially competitive. In a culture where the financial bottom line determines the survival of a practice, music therapists' professional status is paradoxically enhanced, especially in light of the profession's legal disadvantage. This observation, however, would not be applicable where service recipients and their families are struggling to keep their daily needs met.

Theoretical/Philosophical Tradition of Music Therapy Practice and Research

As the first generation of Taiwanese-trained music therapists are expected to enter the job force in 2008, another question to explore is whether the theoretical and philosophical orientations of these new practitioners will reflect the humanistic aspect of Taiwanese culture. The over-seas trained music therapists have introduced techniques from diverse theoretical/philosophical orientations to the practice of music therapy in Taiwan. Nordoff-Robbins' Creative Music Therapy, Neurologic Music Therapy, Orff, guided listening or imagery with music (differentiated from BMGIM), and music therapy procedures in the psychodynamic/psychoanalytic, behavioral, cognitive/rational, and humanistic orientations are clinically applied in various degrees of depth for different populations depending on individual therapists training and style.

Therapists with such training may not be comfortable with the previously mentioned "Music Rx" products; some of which have suggested protocols and are advertised as "manufactured according to Traditional Chinese Medical Theories to produce harmonious healing power with or without meditating exercises." On the other hand, they may not feel prepared to incorporate active musical experiences, such as Tai Chi or other meditating exercises with music, into their therapeutic interventions. If such treatments are considered in accordance with the AMTA's general definition of music therapy, it is clear that more carefully defined, designed and controlled research would be required to determine their effectiveness. Can these "theories" stand such examination? Is their implementation capable of producing replicable results as claimed? Therapist training and competency in the administration of these techniques also needs to be established. In addition to all of these "technical" aspects of music therapy there are also Taiwanese notions about the function of music in the healing process (in an ontological sense) - beyond that of mere superstition - which should serve as a reference in adapting theoretical and philosophical foundations of music therapy practice and research to reflect the clinical culture in Taiwan. Considering that the amount of theses and journal articles in Taiwan on the subject of music therapy has decreased since the 2002-03 peak (National Central Library, 2005 & 2004), these questions hopefully will inspire interests in further research with quality, quantity and diversity.

Conclusion

Music therapy in Taiwan is growing steadily. The increased understanding and incorporation of music therapy as a valid therapeutic intervention is worth celebrating. The strengthening of music therapy preparatory programs and continuing education, although still a work in progress, provides hope for putting more qualified professionals into the job force. Working towards the legal clarification of music therapy as a profession and more collaboration with other healthcare disciplines assures a healthier professional future. These accomplishments are the harvest of years of advocacy by dedicated music therapy practitioners and educators. Nevertheless, these accomplishments also further identify concerns for many Taiwanese music therapists. The Music Therapy Association of Taiwan's need for more power to coordinate the professional affairs of music therapists is foremost identified. This will also facilitate the resolution of legal battles with other professions, education and clinical competencies, ethical and clinical standards, as well as the promotion of research incorporating the function of music that is indigenous to the culture.

The official website of MTAT is now: www.musictherapy.org.tw

Acknowledgement

The writer would like to express her gratitude to Taiwanese music therapy clinicians and educators who are committed to the well being of clients and students. Many thanks also go to the professionals who were willing to share their experiences and assist the writing with invaluable suggestions.

Notes

[1] This Country of the Month article updates ChihChen Sophia Lee's previous column on music therapy in Taiwan, published in Voices in June 2003. The Editors encourage readers to note changes and developments in practice and training in Taiwan during the three-year period.

References

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How to cite this page

Lee, ChihChen Sophia (2006). Music Therapy in Taiwan, 2003-2006. Voices Resources. Retrieved January 09, 2015, from http://testvoices.uib.no/community/?q=country-of-the-month/2006-music-therapy-taiwan-2003-2006